Provider Demographics
NPI:1609640416
Name:SANDERS, BETH (FNP)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 E COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29070-9285
Mailing Address - Country:US
Mailing Address - Phone:803-532-1580
Mailing Address - Fax:
Practice Address - Street 1:338 E COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:SC
Practice Address - Zip Code:29070-9285
Practice Address - Country:US
Practice Address - Phone:803-532-1580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28128363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily