Healthcare Provider Details

I. General information

NPI: 1780718577
Provider Name (Legal Business Name): DWIGHT EARL SANDERSON CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 03/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 WYNTRE BROOKE DR
YORK PA
17403-4509
US

IV. Provider business mailing address

106 E RIVER RD
MIFFLINTOWN PA
17059-7852
US

V. Phone/Fax

Practice location:
  • Phone: 717-741-9444
  • Fax:
Mailing address:
  • Phone: 410-913-4659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberUP001943C
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR098563
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: