Provider Demographics
NPI:1790431039
Name:SANDERS, TEARRIA DIANN
Entity Type:Individual
Prefix:
First Name:TEARRIA
Middle Name:DIANN
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 1:13319 S 90TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-3463
Mailing Address - Country:US
Mailing Address - Phone:918-231-3277
Mailing Address - Fax:
Practice Address - Street 1:252 W 17TH PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-4654
Practice Address - Country:US
Practice Address - Phone:918-550-3048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist