Healthcare Provider Details

I. General information

NPI: 1114272325
Provider Name (Legal Business Name): SANDERS NURSE ANESTHESIA SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 07/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9308 S TOLEDO AVE
TULSA OK
74137-2739
US

IV. Provider business mailing address

9900 E 570 RD
CATOOSA OK
74015-6294
US

V. Phone/Fax

Practice location:
  • Phone: 918-728-8020
  • Fax:
Mailing address:
  • Phone: 918-344-0807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LAVONNA KAY SANDERS
Title or Position: PRESIDENT
Credential: CRNA
Phone: 918-344-0807