Provider Demographics
NPI:1962005397
Name:SANDERS, KAREN A (IP)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:A
Last Name:SANDERS
Suffix:
Gender:F
Credentials:IP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 NAPOLEON LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN FURNACE
Mailing Address - State:OH
Mailing Address - Zip Code:45629-8880
Mailing Address - Country:US
Mailing Address - Phone:740-354-9740
Mailing Address - Fax:
Practice Address - Street 1:147 NAPOLEON LN
Practice Address - Street 2:
Practice Address - City:FRANKLIN FURNACE
Practice Address - State:OH
Practice Address - Zip Code:45629-8880
Practice Address - Country:US
Practice Address - Phone:740-354-9740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2944603Medicaid