Provider Demographics
NPI:1669117610
Name:SANDERSON, KATHERINE FRANCES (NP-C)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:FRANCES
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3646 COOK RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-9288
Mailing Address - Country:US
Mailing Address - Phone:615-812-5635
Mailing Address - Fax:
Practice Address - Street 1:3033 STATE RD STE 204
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-3600
Practice Address - Country:US
Practice Address - Phone:330-253-9727
Practice Address - Fax:330-926-5866
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0030772363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily