Provider Demographics
NPI:1972753465
Name:SANDERLIN, MARY LOUISE (CNM)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:LOUISE
Last Name:SANDERLIN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 COUNTY ROAD E W
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-8152
Mailing Address - Country:US
Mailing Address - Phone:651-490-0433
Mailing Address - Fax:
Practice Address - Street 1:1030 COUNTY ROAD E W
Practice Address - Street 2:SUITE 200
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-8152
Practice Address - Country:US
Practice Address - Phone:651-490-0433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1721443367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife