Provider Demographics
NPI:1013168814
Name:SANDERS, MARISSA KAY (LPN)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:KAY
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5925 TILGHMAN ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-9156
Mailing Address - Country:US
Mailing Address - Phone:610-434-7277
Mailing Address - Fax:
Practice Address - Street 1:5925 TILGHMAN ST
Practice Address - Street 2:SUITE 150
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9156
Practice Address - Country:US
Practice Address - Phone:610-434-7277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN283357164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse