Provider Demographics
NPI:1710026307
Name:SANDERS, JOYCE DELAINE
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:DELAINE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 29
Mailing Address - Street 2:4 BULLARD ROAD
Mailing Address - City:TUPELO
Mailing Address - State:OK
Mailing Address - Zip Code:74572-9705
Mailing Address - Country:US
Mailing Address - Phone:580-845-2444
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 29
Practice Address - Street 2:4 BULLARD ROAD
Practice Address - City:TUPELO
Practice Address - State:OK
Practice Address - Zip Code:74572-9705
Practice Address - Country:US
Practice Address - Phone:580-845-2444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor