Healthcare Provider Details

I. General information

NPI: 1710123260
Provider Name (Legal Business Name): MRS. DEBRA ANN SANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. DEBRA ANN SANDERS-WALKER

II. Dates (important events)

Enumeration Date: 01/05/2009
Last Update Date: 01/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7249 HANOVER PKWY SUITE D
GREENBELT MD
20770-3608
US

IV. Provider business mailing address

7249 HANOVER PKWY SUITE D
GREENBELT MD
20770-3608
US

V. Phone/Fax

Practice location:
  • Phone: 301-345-3255
  • Fax: 301-390-1029
Mailing address:
  • Phone: 301-345-3255
  • Fax: 301-390-1029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number74363
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: