Provider Demographics
NPI:1457611584
Name:SANDER, DARA L (NP)
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:L
Last Name:SANDER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DARA
Other - Middle Name:L
Other - Last Name:ORMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 HADLEY RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-1883
Practice Address - Country:US
Practice Address - Phone:317-834-9393
Practice Address - Fax:317-834-9399
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004000A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201079370Medicaid
IN201079370Medicaid
INP01246669Medicare PIN