Provider Demographics
NPI:1467476903
Name:SANDERS, LISA JENNIFER (FNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JENNIFER
Last Name:SANDERS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:JENNIFER
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1512 NE AMANDA LN
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-5910
Mailing Address - Country:US
Mailing Address - Phone:816-600-5041
Mailing Address - Fax:
Practice Address - Street 1:900 W 48TH PL STE 900
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-1899
Practice Address - Country:US
Practice Address - Phone:816-572-4615
Practice Address - Fax:816-817-5180
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45809363LF0000X
MO2005036712363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOX93000034Medicare PIN