Provider Demographics
NPI:1912036534
Name:SANDER, PAMELA LYNN (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:LYNN
Last Name:SANDER
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:LYNN
Other - Last Name:SANDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:2000 EAST LINCOLN ROAD
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745
Mailing Address - Country:US
Mailing Address - Phone:580-286-6639
Mailing Address - Fax:580-286-5206
Practice Address - Street 1:2000 EAST LINCOLN ROAD
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745
Practice Address - Country:US
Practice Address - Phone:580-286-6639
Practice Address - Fax:580-286-5206
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0052643163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management