Provider Demographics
NPI:1093084170
Name:SANDERS, MINNIE CHAN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MINNIE
Middle Name:CHAN
Last Name:SANDERS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:MINNIE
Other - Middle Name:J
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:98 N BROADWAY
Mailing Address - Street 2:SUITE 421
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-1536
Mailing Address - Country:US
Mailing Address - Phone:410-955-6211
Mailing Address - Fax:410-955-1617
Practice Address - Street 1:98 N BROADWAY
Practice Address - Street 2:SUITE 421
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-1536
Practice Address - Country:US
Practice Address - Phone:410-955-6211
Practice Address - Fax:410-955-1617
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR178849363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily