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General NPI Number Information
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NPI Number | 1801893540
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Entity Type | Individual
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Provider Name | THERESA M SANDER CRNP
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Gender | Female
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 208 RIDGE RD
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City | COGAN STATION
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State | PA
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Zip | 17728-9734
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Country | US
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Telephone | 570-494-0345
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Fax | 570-494-0345
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Provider Business Mailing Address
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Address Line | 208 RIDGE RD
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City | COGAN STATION
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State | PA
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Zip | 17728-9734
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Country | US
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Telephone | 570-494-0345
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Fax | 570-494-0345
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | TP003773B
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License Number State | PA
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