Healthcare Provider Details

I. General information

NPI: 1750576971
Provider Name (Legal Business Name): TEQUITTA N SANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 RIDGE RUN CIR
LIMA OH
45805-1093
US

IV. Provider business mailing address

1421 RIDGE RUN CIR
LIMA OH
45805-1093
US

V. Phone/Fax

Practice location:
  • Phone: 419-371-3749
  • Fax:
Mailing address:
  • Phone: 419-371-3749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN.140262-M-IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: