Provider Demographics
NPI:1083192637
Name:SANDERS, KAPESTRIAL DEITRA (LVN)
Entity Type:Individual
Prefix:
First Name:KAPESTRIAL
Middle Name:DEITRA
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5726 W HAUSMAN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-1651
Mailing Address - Country:US
Mailing Address - Phone:210-349-7030
Mailing Address - Fax:210-349-0097
Practice Address - Street 1:5726 W HAUSMAN RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-1651
Practice Address - Country:US
Practice Address - Phone:210-349-7030
Practice Address - Fax:210-349-0097
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-04
Last Update Date:2018-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX304192164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse