Provider Demographics
NPI:1760089148
Name:SANDERS, AMBOR LYNN (RN)
Entity Type:Individual
Prefix:MRS
First Name:AMBOR
Middle Name:LYNN
Last Name:SANDERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37870 76TH ST
Mailing Address - Street 2:
Mailing Address - City:COVERT
Mailing Address - State:MI
Mailing Address - Zip Code:49043-9783
Mailing Address - Country:US
Mailing Address - Phone:269-408-6918
Mailing Address - Fax:269-926-0123
Practice Address - Street 1:1022 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-3036
Practice Address - Country:US
Practice Address - Phone:269-926-0015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704347899163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)