Provider Demographics
NPI:1710247564
Name:SANDERS, LAUREN JACQUELINE (FNP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:JACQUELINE
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 1:1065 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-2417
Mailing Address - Country:US
Mailing Address - Phone:718-589-2440
Mailing Address - Fax:718-991-4516
Practice Address - Street 1:1167 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-5417
Practice Address - Country:US
Practice Address - Phone:718-221-0198
Practice Address - Fax:718-221-8169
Is Sole Proprietor?:No
Enumeration Date:2012-05-25
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337254363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY337254OtherLICENSE
NY00695941Medicaid
NYG10000410Medicare Oscar/Certification
NY337254OtherLICENSE
NY00695941Medicaid