Healthcare Provider Details

I. General information

NPI: 1316043409
Provider Name (Legal Business Name): SANDRA L. ANDERSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 W 74TH ST SUITE 269
OVERLAND PARK KS
66204-2204
US

IV. Provider business mailing address

8901 W 74TH ST SUITE 269
OVERLAND PARK KS
66204-2204
US

V. Phone/Fax

Practice location:
  • Phone: 913-676-7585
  • Fax: 913-676-8189
Mailing address:
  • Phone: 913-676-7585
  • Fax: 913-676-8189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License Number118882
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number74679
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: