Healthcare Provider Details

I. General information

NPI: 1982856688
Provider Name (Legal Business Name): MARY E. SANDERS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 06/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1664 N VIRGINIA ST MAIL STOP 153/REDFIELD BLDG.
RENO NV
89557-0001
US

IV. Provider business mailing address

1664 N VIRGINIA ST MAIL STOP 153/REDFIELD BLDG.
RENO NV
89557-0001
US

V. Phone/Fax

Practice location:
  • Phone: 775-746-0645
  • Fax: 775-784-4468
Mailing address:
  • Phone: 775-746-0645
  • Fax: 775-784-4468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number519895
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: