Provider Demographics
NPI:1407295355
Name:SANDERS, JENNA A (ANP-C)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:A
Last Name:SANDERS
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:A
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5551 WINGHAVEN BLVD
Mailing Address - Street 2:STE 290
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-3617
Mailing Address - Country:US
Mailing Address - Phone:636-695-2575
Mailing Address - Fax:314-590-5938
Practice Address - Street 1:5551 WINGHAVEN BLVD
Practice Address - Street 2:STE 290
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-3617
Practice Address - Country:US
Practice Address - Phone:636-695-2575
Practice Address - Fax:314-590-5938
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013014534363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health