Provider Demographics
NPI:1437711488
Name:SANDERS, KATRINA CHEREE
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:CHEREE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1098 RICHTON PL
Mailing Address - Street 2:
Mailing Address - City:RICHTON PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60471-1320
Mailing Address - Country:US
Mailing Address - Phone:423-637-9735
Mailing Address - Fax:708-231-9920
Practice Address - Street 1:1098 RICHTON PL
Practice Address - Street 2:
Practice Address - City:RICHTON PARK
Practice Address - State:IL
Practice Address - Zip Code:60471-1320
Practice Address - Country:US
Practice Address - Phone:423-637-9735
Practice Address - Fax:708-231-9920
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-30
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)