Provider Demographics
NPI:1407334766
Name:SANDERS, TAMRA L (MSN, BSN, RN)
Entity Type:Individual
Prefix:
First Name:TAMRA
Middle Name:L
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MSN, BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N KENILWORTH AVE APT 4E
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1216
Mailing Address - Country:US
Mailing Address - Phone:773-915-3189
Mailing Address - Fax:
Practice Address - Street 1:110 N KENILWORTH AVE APT 4E
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1216
Practice Address - Country:US
Practice Address - Phone:773-915-3189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041358187163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool