Provider Demographics
NPI:1225322001
Name:SANDERSON, JOSEPH LEE JR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:LEE
Last Name:SANDERSON
Suffix:JR
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 1:1001 TAWANA CT
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-7647
Mailing Address - Country:US
Mailing Address - Phone:919-218-6824
Mailing Address - Fax:
Practice Address - Street 1:1001 TAWANA CT
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-7647
Practice Address - Country:US
Practice Address - Phone:919-218-6824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC216787163W00000X
NC088362367500000X
FL9334361367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered