Provider Demographics
NPI:1265777106
Name:SANDER, DAWN M (ANP)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:M
Last Name:SANDER
Suffix:
Gender:
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-273-7373
Mailing Address - Fax:888-840-6225
Practice Address - Street 1:1020 N MASON RD
Practice Address - Street 2:DIV SURG VASCULAR, STE 225
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6666
Practice Address - Country:US
Practice Address - Phone:314-273-7373
Practice Address - Fax:888-840-6225
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012040367363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420001576Medicaid
ILENROLLEDMedicaid