Provider Demographics
NPI:1205229135
Name:SANDERS, MARY C (FNP-C, BC-ADM, CDCES)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:C
Last Name:SANDERS
Suffix:
Gender:F
Credentials:FNP-C, BC-ADM, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 STATE ST FL 4
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3776
Mailing Address - Country:US
Mailing Address - Phone:207-400-8500
Mailing Address - Fax:207-400-8508
Practice Address - Street 1:144 STATE ST FL 4
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3776
Practice Address - Country:US
Practice Address - Phone:207-400-8500
Practice Address - Fax:207-400-8508
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-17
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP191272363L00000X
COAPN.0991682-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily