Provider Demographics
NPI:1508252644
Name:SANDERS, LARA (APN)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3008
Mailing Address - Country:US
Mailing Address - Phone:501-552-4710
Mailing Address - Fax:501-376-2084
Practice Address - Street 1:2500 E 6TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3008
Practice Address - Country:US
Practice Address - Phone:501-552-4710
Practice Address - Fax:501-376-2084
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAG0215073363LA2200X
ARA004421363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health