Healthcare Provider Details

I. General information

NPI: 1417365156
Provider Name (Legal Business Name): VERONICA SANDERS R.N., B.S.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2014
Last Update Date: 07/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1068 CRESTHAVEN RD SUITE 100
MEMPHIS TN
38119-0800
US

IV. Provider business mailing address

1068 CRESTHAVEN RD SUITE 100
MEMPHIS TN
38119-0800
US

V. Phone/Fax

Practice location:
  • Phone: 901-761-9551
  • Fax: 901-761-9466
Mailing address:
  • Phone: 901-761-9551
  • Fax: 901-761-9466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0121X
TaxonomyPlastic Surgery Registered Nurse
License Number0000123005
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: