Provider Demographics
NPI:1558679407
Name:SANDERS, CARLETTA NICOLE (RN)
Entity Type:Individual
Prefix:
First Name:CARLETTA
Middle Name:NICOLE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2098 WASHINGTON DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-1357
Mailing Address - Country:US
Mailing Address - Phone:216-469-7439
Mailing Address - Fax:
Practice Address - Street 1:2098 WASHINGTON DR
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-1357
Practice Address - Country:US
Practice Address - Phone:216-469-7439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.330747163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse