MEDICARE: LATONYA SANDERS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	247ZC0005X	Clinical Laboratory Director (Non-physician)	36D2248553	OH
2	163W00000X	Registered Nurse	RN457823	OH

General Provider Information

NPI Number	:	1114670932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATONYA SANDERS RN

Provider Business Mailing Address
First Line	:	4443 READING RD # 203
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45229-1252
Country	:	US
Telephone Number	:	513-899-8894
Fax Number	:

Provider Business Practice Location Address
First Line	:	4443 READING RD # 203
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45229-1252
Country	:	US
Telephone Number	:	513-899-8894
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2022
Last Update Date	:	02/03/2022

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