Provider Demographics
NPI:1629526926
Name:SANDER, TEAL (PA-C)
Entity Type:Individual
Prefix:
First Name:TEAL
Middle Name:
Last Name:SANDER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:KS
Mailing Address - Zip Code:67640-0128
Mailing Address - Country:US
Mailing Address - Phone:785-650-8712
Mailing Address - Fax:785-302-9547
Practice Address - Street 1:98 CHICAGO ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:KS
Practice Address - Zip Code:67640-9047
Practice Address - Country:US
Practice Address - Phone:785-650-8712
Practice Address - Fax:785-302-9547
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01926363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant