Provider Demographics
NPI:1467792523
Name:SANDER, MARIE BERNICE (RN, ANP-BC)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:BERNICE
Last Name:SANDER
Suffix:
Gender:F
Credentials:RN, ANP-BC
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:BERNICE
Other - Last Name:SANDER-BOLEGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, ANP-BC
Mailing Address - Street 1:851 E 5TH ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-3135
Mailing Address - Country:US
Mailing Address - Phone:636-390-9090
Mailing Address - Fax:636-390-9091
Practice Address - Street 1:851 E 5TH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-3135
Practice Address - Country:US
Practice Address - Phone:636-390-9090
Practice Address - Fax:636-390-9091
Is Sole Proprietor?:No
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012040371363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health