Provider Demographics
NPI:1083971931
Name:SANDERS, KIMBERLY MONIQUE (RN)
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:MONIQUE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 18TH ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-2324
Mailing Address - Country:US
Mailing Address - Phone:716-830-5413
Mailing Address - Fax:
Practice Address - Street 1:16 18TH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-2324
Practice Address - Country:US
Practice Address - Phone:716-830-5413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-17
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY505587-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse