Provider Demographics
NPI:1295546141
Name:SANDERS, MARILOU GERICKA (NP)
Entity type:Individual
Prefix:MRS
First Name:MARILOU
Middle Name:GERICKA
Last Name:SANDERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:MARILOU
Other - Middle Name:G
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:102 RIGLAW LN
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-5988
Mailing Address - Country:US
Mailing Address - Phone:813-361-4877
Mailing Address - Fax:
Practice Address - Street 1:440 N DUNCAN BYP
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:SC
Practice Address - Zip Code:29379-8604
Practice Address - Country:US
Practice Address - Phone:864-424-9576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29745363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty