Provider Demographics
NPI:1760836860
Name:SANDERS, SUSAN RICALTON (RN)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:RICALTON
Last Name:SANDERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:MARIE
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1589 HILL RISE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2588
Mailing Address - Country:US
Mailing Address - Phone:859-255-0500
Mailing Address - Fax:859-233-9231
Practice Address - Street 1:1589 HILL RISE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2588
Practice Address - Country:US
Practice Address - Phone:859-255-0500
Practice Address - Fax:859-233-9231
Is Sole Proprietor?:No
Enumeration Date:2016-04-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1057835163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)