Provider Demographics
NPI:1083655138
Name:SANDERS, SUSAN LESLIE (ANP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LESLIE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3851 PIPER ST
Mailing Address - Street 2:SUITE U340
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4684
Mailing Address - Country:US
Mailing Address - Phone:907-562-0321
Mailing Address - Fax:907-562-2683
Practice Address - Street 1:3851 PIPER ST
Practice Address - Street 2:SUITE U340
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4684
Practice Address - Country:US
Practice Address - Phone:907-562-0321
Practice Address - Fax:907-562-2683
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK695363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMS0979572OtherDEA
AKR59748Medicare UPIN