Provider Demographics
NPI:1629219720
Name:SANDERS, EDWARD MOLTON II (RN)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:MOLTON
Last Name:SANDERS
Suffix:II
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 EXETER RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2954
Mailing Address - Country:US
Mailing Address - Phone:901-818-2183
Mailing Address - Fax:901-682-9522
Practice Address - Street 1:1900 EXETER RD
Practice Address - Street 2:SUITE 210
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2954
Practice Address - Country:US
Practice Address - Phone:901-818-2183
Practice Address - Fax:901-682-9522
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN 14189367500000X
TNRN0000131203163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1514315Medicaid
1629219720OtherCHAMPUS/HUMANA TRICARE
TN4223156OtherBLUE CROSS
MS00079839Medicaid
TNP00800809OtherRAILROAD MEDICARE
TNP00800809OtherRAILROAD MEDICARE