Provider Demographics
NPI:1164587184
Name:SANDERS, BRENDA LYNNE WILDER (MD PHD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LYNNE WILDER
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:LYNNE
Other - Last Name:WILDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:316 MARTIN LUTHER KIND JR WAY
Mailing Address - Street 2:#212
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405
Mailing Address - Country:US
Mailing Address - Phone:253-383-5777
Mailing Address - Fax:253-627-0855
Practice Address - Street 1:1628 SOUTH MILDRED
Practice Address - Street 2:#101
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98465
Practice Address - Country:US
Practice Address - Phone:253-564-8005
Practice Address - Fax:253-627-0855
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00046346208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics