Provider Demographics
NPI:1558618330
Name:SANDERS, ALISA JEANNE (RN,IBCLC,RLC)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:JEANNE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:RN,IBCLC,RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2636 SOUTH LOOP WEST,
Mailing Address - Street 2:135
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054
Mailing Address - Country:US
Mailing Address - Phone:713-839-0527
Mailing Address - Fax:713-839-0683
Practice Address - Street 1:2636 SOUTH LOOP WEST, SUITE 135
Practice Address - Street 2:SUITE 135
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054
Practice Address - Country:US
Practice Address - Phone:713-839-0527
Practice Address - Fax:713-839-0683
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX563735163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant