Healthcare Provider Details

I. General information

NPI: 1326173303
Provider Name (Legal Business Name): STEPHANIE RAE SANDERSON CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE
ALBUQUERQUE NM
87106-2745
US

IV. Provider business mailing address

PO BOX 3461
EDGEWOOD NM
87015-3461
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2607
  • Fax:
Mailing address:
  • Phone: 505-281-1657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License NumberR38522
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: