Provider Demographics
NPI:1043347461
Name:SANDEN, STEFANIE LYNNE (NP-C)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:LYNNE
Last Name:SANDEN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 BRUNDAGE LANE
Mailing Address - Street 2:CLINICA SIERRA VISTA
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93304
Mailing Address - Country:US
Mailing Address - Phone:661-323-6086
Mailing Address - Fax:661-324-6301
Practice Address - Street 1:301 BRUNDAGE LANE
Practice Address - Street 2:CLINICA SIERRA VISTA
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304
Practice Address - Country:US
Practice Address - Phone:661-323-6086
Practice Address - Fax:661-324-6301
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO173888163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05236371Medicaid