Provider Demographics
NPI:1174865976
Name:SANDERSON, JOSEPH EDWARD (CHA-1)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:EDWARD
Last Name:SANDERSON
Suffix:
Gender:M
Credentials:CHA-1
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 69
Mailing Address - Street 2:
Mailing Address - City:HYDABURG
Mailing Address - State:AK
Mailing Address - Zip Code:99922-0069
Mailing Address - Country:US
Mailing Address - Phone:907-285-3462
Mailing Address - Fax:907-285-3463
Practice Address - Street 1:8TH STREET EXTENSION
Practice Address - Street 2:
Practice Address - City:HYDABURG
Practice Address - State:AK
Practice Address - Zip Code:99922-0000
Practice Address - Country:US
Practice Address - Phone:907-285-3462
Practice Address - Fax:907-285-3463
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker