Healthcare Provider Details

I. General information

NPI: 1326151085
Provider Name (Legal Business Name): LAVONNA K SANDERS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 04/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 N MUSKOGEE PL
CLAREMORE OK
74017-3058
US

IV. Provider business mailing address

9900 E 570 RD
CATOOSA OK
74015-6294
US

V. Phone/Fax

Practice location:
  • Phone: 918-341-2556
  • Fax: 918-342-2304
Mailing address:
  • Phone: 918-344-0807
  • Fax: 918-266-0170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR49134
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: