Provider Demographics
NPI:1770344673
Name:SANDERS, ALEXIS (CNA, CMA HHA)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:CNA, CMA HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 HARDING ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-2852
Mailing Address - Country:US
Mailing Address - Phone:316-730-6095
Mailing Address - Fax:
Practice Address - Street 1:1255 HARDING ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-2852
Practice Address - Country:US
Practice Address - Phone:316-730-6095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS239252374U00000X, 376K00000X
MOMO028592501350376K00000X
OK320665400822376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide