Healthcare Provider Details

I. General information

NPI: 1487075875
Provider Name (Legal Business Name): NICOLE L SANDERS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2014
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 STONY POINT PKWY STE 100
RICHMOND VA
23235-1968
US

IV. Provider business mailing address

PO BOX 840853
DALLAS TX
75284-0853
US

V. Phone/Fax

Practice location:
  • Phone: 804-775-4500
  • Fax: 804-545-0758
Mailing address:
  • Phone: 972-233-1999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP140860
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0001229493
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: