Provider Demographics
NPI:1720353469
Name:SANDERS, BRENDON M (RN)
Entity Type:Individual
Prefix:
First Name:BRENDON
Middle Name:M
Last Name:SANDERS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7587 W STATE ROUTE 29
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-9349
Mailing Address - Country:US
Mailing Address - Phone:937-508-6493
Mailing Address - Fax:
Practice Address - Street 1:7587 W STATE ROUTE 29
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-9349
Practice Address - Country:US
Practice Address - Phone:937-508-6493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN311586163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health