Provider Demographics
NPI:1568781243
Name:SANDERS, BRENDA LEE (RN)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:LEE
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 1:4106 WILDER RD # 234
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2239
Mailing Address - Country:US
Mailing Address - Phone:989-686-7895
Mailing Address - Fax:
Practice Address - Street 1:4106 WILDER RD # 234
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2239
Practice Address - Country:US
Practice Address - Phone:989-686-7895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704221229163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse