Provider Demographics
NPI:1104012178
Name:SANDERS, SARAH LIRETTE (PA)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:LIRETTE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:SARAH
Other - Middle Name:MARIE
Other - Last Name:LIRETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:8001 YOUREE DRIVE
Mailing Address - Street 2:SUITE 960
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2355
Mailing Address - Country:US
Mailing Address - Phone:318-212-3706
Mailing Address - Fax:318-212-3708
Practice Address - Street 1:8001 YOUREE DRIVE
Practice Address - Street 2:SUITE 960
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-2355
Practice Address - Country:US
Practice Address - Phone:318-212-3706
Practice Address - Fax:318-212-3708
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA200135363A00000X
LAPA.200135.RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5F600P181Medicare PIN
LA1017892Medicare PIN
LA5CJ18P884Medicare PIN