Provider Demographics
NPI:1558329292
Name:SANDERS, SHIRLEY JOANNE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:JOANNE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:JOANNE
Other - Last Name:BRUENJES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:806 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-6264
Mailing Address - Country:US
Mailing Address - Phone:812-748-3412
Mailing Address - Fax:812-377-6024
Practice Address - Street 1:3203 MIDDLE ROAD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-4427
Practice Address - Country:US
Practice Address - Phone:812-373-2700
Practice Address - Fax:812-373-2710
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000212363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000990928OtherANTHEM PIN
IN054962POtherSIHO
IN201085480Medicaid
IN500011512OtherMEDICARE RAILROAD
IN71000212OtherIN NP LINCENSE
1407861164OtherGROUP NPI
IN000000990928OtherANTHEM PIN
IN71000212OtherIN NP LINCENSE
1407861164OtherGROUP NPI