MEDICARE: MARZETTA SANDERS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	3747P1801X	Personal Care Attendant
2	372500000X	Chore Provider
3	372600000X	Adult Companion
4	3747A0650X	Attendant Care Provider
5	376J00000X	Homemaker

General Provider Information

NPI Number	:	1669972907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARZETTA SANDERS

Provider Business Mailing Address
First Line	:	535 S DECATUR BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-3910
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2655 W LAKE MEAD BLVD APT 1194
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-4885
Country	:	US
Telephone Number	:	702-561-3874
Fax Number	:

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

Provider Enumeration Date	:	02/13/2018
Last Update Date	:	02/13/2018

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Directions to “ MARZETTA SANDERS ” Practice Location

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