Provider Demographics
NPI:1326151085
Name:SANDERS, LAVONNA K (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:LAVONNA
Middle Name:K
Last Name:SANDERS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 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:918-266-0170
Practice Address - Street 1:1202 N MUSKOGEE PL
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-3058
Practice Address - Country:US
Practice Address - Phone:918-341-2556
Practice Address - Fax:918-342-2304
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR49134367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100783920AMedicaid
OK1285810051OtherMEDICARE GROUP PIN
OK249234403Medicare PIN