Provider Demographics
NPI:1093019952
Name:SANDERS, SUSAN LEE (DNP, FNP-C, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LEE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:DNP, FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8285 S FIREFLY DR
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:IN
Mailing Address - Zip Code:46064-9296
Mailing Address - Country:US
Mailing Address - Phone:765-610-5006
Mailing Address - Fax:626-666-6731
Practice Address - Street 1:3520 E LITTLE CREEK RD STE D
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-3460
Practice Address - Country:US
Practice Address - Phone:765-610-5006
Practice Address - Fax:623-666-6731
Is Sole Proprietor?:No
Enumeration Date:2011-01-06
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPENDING363LP0808X
IN71003500A363LF0000X, 363LP0808X
VA0024184018363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily