Healthcare Provider Details

I. General information

NPI: 1205307881
Provider Name (Legal Business Name): HEATHER MICHELLE SANDERS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2018
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 CHAMBERS ST
EUGENE OR
97405-1861
US

IV. Provider business mailing address

1193 CEDAR RIDGE DR
EUGENE OR
97401-1916
US

V. Phone/Fax

Practice location:
  • Phone: 541-513-5975
  • Fax:
Mailing address:
  • Phone: 541-513-5975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number200641051RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201904775NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: