Healthcare Provider Details

I. General information

NPI: 1730977380
Provider Name (Legal Business Name): JELESA ROSS SANDERS BSN, RN, ERRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2025
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GREENFIELD ST
WILMINGTON NC
28401-6456
US

IV. Provider business mailing address

3185 BLUE BANKS LOOP RD NE
LELAND NC
28451-8965
US

V. Phone/Fax

Practice location:
  • Phone: 910-798-3500
  • Fax: 910-798-7834
Mailing address:
  • Phone: 910-622-1947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number307636
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: