Provider Demographics
NPI:1114027745
Name:SANDERSON, STEPHEN WAYNE (CRNA)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:WAYNE
Last Name:SANDERSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70333
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77270-0333
Mailing Address - Country:US
Mailing Address - Phone:832-549-4403
Mailing Address - Fax:
Practice Address - Street 1:3530 CLINE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77020-6128
Practice Address - Country:US
Practice Address - Phone:832-549-4403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX534642367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered