Provider Demographics
NPI:1205189230
Name:SANDERS, PATRICIA KAY (IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:KAY
Last Name:SANDERS
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:PATSY
Other - Middle Name:KAY
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:IBCLC
Mailing Address - Street 1:277 NE SANDERS DR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:OK
Mailing Address - Zip Code:73538-2303
Mailing Address - Country:US
Mailing Address - Phone:580-583-0152
Mailing Address - Fax:
Practice Address - Street 1:277 NE SANDERS DR
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:OK
Practice Address - Zip Code:73538-2303
Practice Address - Country:US
Practice Address - Phone:580-583-0152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19010598174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN