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General NPI Number Information
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NPI Number | 1518746742
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Entity Type | Individual
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Provider Name | DALTON SANDERS DNP, MBA, CRNA, APRN
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Gender | Male
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Dates
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Enumeration Date | 09/26/2023
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 3100 OAK GROVE RD
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-1573
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Country | US
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Telephone | 573-776-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 3010 JASON AVE
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City | VAN BUREN
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State | MO
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Zip | 63965-7277
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Country | US
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Telephone | 573-450-8368
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 2025019587
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License Number State | MO
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