Provider Demographics
NPI:1811245103
Name:SANDERS, DENNIS MADISON JR (LPN)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:MADISON
Last Name:SANDERS
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4516 E 47TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64130-2228
Mailing Address - Country:US
Mailing Address - Phone:816-785-9707
Mailing Address - Fax:
Practice Address - Street 1:4516 E 47TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64130-2228
Practice Address - Country:US
Practice Address - Phone:816-785-9707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-17
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012019090164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse