MEDICARE: ELISSA SANDER

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	363LW0102X	Women's Health Nurse Practitioner	464853	OH

General Provider Information

NPI Number	:	1588512685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISSA SANDER

Provider Business Mailing Address
First Line	:	197 JACKSON ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43206-1228
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	197 JACKSON ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43206-1228
Country	:	US
Telephone Number	:	513-594-8827
Fax Number	:

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

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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