Provider Demographics
NPI:1922336197
Name:SANDERS, JEWEL TOYIA
Entity Type:Individual
Prefix:MS
First Name:JEWEL
Middle Name:TOYIA
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 1:9192 E WALDEN DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-3360
Mailing Address - Country:US
Mailing Address - Phone:313-721-3787
Mailing Address - Fax:
Practice Address - Street 1:23023 ORCHARD LAKE RD
Practice Address - Street 2:SUITE C
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-3209
Practice Address - Country:US
Practice Address - Phone:248-987-2934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI8004660006372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion