Provider Demographics
NPI:1114272325
Name:SANDERS NURSE ANESTHESIA SERVICES, INC
Entity Type:Organization
Organization Name:SANDERS NURSE ANESTHESIA SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAVONNA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:918-344-0807
Mailing Address - Street 1:9900 E 570 RD
Mailing Address - Street 2:
Mailing Address - City:CATOOSA
Mailing Address - State:OK
Mailing Address - Zip Code:74015-6294
Mailing Address - Country:US
Mailing Address - Phone:918-344-0807
Mailing Address - Fax:
Practice Address - Street 1:9308 S TOLEDO AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-2739
Practice Address - Country:US
Practice Address - Phone:918-728-8020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty