Provider Demographics
NPI:1942390190
Name:FAHRING, SAUNDRA LEE
Entity Type:Individual
Prefix:MRS
First Name:SAUNDRA
Middle Name:LEE
Last Name:FAHRING
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SAUNDRA
Other - Middle Name:LEE
Other - Last Name:VAN ATTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12415 E SUTTER MILL ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749-8209
Mailing Address - Country:US
Mailing Address - Phone:520-749-5271
Mailing Address - Fax:520-749-5246
Practice Address - Street 1:492 SO BLUE RIVER LOOP
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:AZ
Practice Address - Zip Code:85641-2262
Practice Address - Country:US
Practice Address - Phone:520-762-1552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN0379083747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ140484OtherAHCCS THRU DDD