MEDICARE: MRS. NANCY HARRELL SANDERSON CRNA

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	163W00000X	Registered Nurse	RN037457	GA

General Provider Information

NPI Number	:	1154323186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NANCY HARRELL SANDERSON CRNA

Provider Business Mailing Address
First Line	:	1180 CORRY RD
Second Line	:
City	:	UNION POINT
State	:	GA
Zip	:	30669-2849
Country	:	US
Telephone Number	:	706-486-2848
Fax Number	:	706-486-2981

Provider Business Practice Location Address
First Line	:	1180 CORRY RD
Second Line	:
City	:	UNION POINT
State	:	GA
Zip	:	30669-2849
Country	:	US
Telephone Number	:	706-486-2848
Fax Number	:	706-486-2981

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	07/09/2007

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