Provider Demographics
NPI:1689086092
Name:SANDERS, DENISE (CNA)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2652 FLYING CLOUD CT
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46011-4752
Mailing Address - Country:US
Mailing Address - Phone:317-938-0412
Mailing Address - Fax:
Practice Address - Street 1:2652 FLYING CLOUD CT
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-4752
Practice Address - Country:US
Practice Address - Phone:317-938-0412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INCNA1104143376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide