Healthcare Provider Details

I. General information

NPI: 1073594875
Provider Name (Legal Business Name): MIRIAM MAXWELL SANDERS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 CARPENTER RD ANDREW RADER USAHC
FT MYER VA
22211-1009
US

IV. Provider business mailing address

3110 MERRYDALE DR
UPPER MARLBORO MD
20772-7731
US

V. Phone/Fax

Practice location:
  • Phone: 703-696-2977
  • Fax: 703-696-0103
Mailing address:
  • Phone: 301-627-8681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberR090263
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: