Provider Demographics
NPI:1760027254
Name:SANDERS, AMANDA RACHAEL (APRN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RACHAEL
Last Name:SANDERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 CAMPUS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2896
Mailing Address - Country:US
Mailing Address - Phone:540-536-5100
Mailing Address - Fax:
Practice Address - Street 1:97 ADMINISTRATIVE DR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-6378
Practice Address - Country:US
Practice Address - Phone:304-350-3200
Practice Address - Fax:304-350-3240
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-08
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024182440363L00000X
TXAP143515363LF0000X
WV110359363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP143515OtherTEXAS BOARD OF NURSING APRN LICENSE