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NPI Code Detail

MEDICARE: MR. DENNIS MADISON SANDERS JR. LPN

MEDICARE: MR. DENNIS MADISON SANDERS JR. LPN
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
1164W00000XLicensed Practical Nurse2012019090MO

General Provider Information

NPI Number : 1811245103
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DENNIS MADISON SANDERS JR. LPN
Provider Business Mailing Address
First Line : 4516 E 47TH ST
Second Line :
City : KANSAS CITY
State : MO
Zip : 64130-2228
Country : US
Telephone Number : 816-785-9707
Fax Number :
Provider Business Practice Location Address
First Line : 4516 E 47TH ST
Second Line :
City : KANSAS CITY
State : MO
Zip : 64130-2228
Country : US
Telephone Number : 816-785-9707
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2012
Last Update Date : 08/17/2012

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