Provider Demographics
NPI:1124441928
Name:SANDERSON, MARSHA (APN, WHNP-BC)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:APN, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 WILLIAMSBURG DR
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:TN
Mailing Address - Zip Code:38004-7893
Mailing Address - Country:US
Mailing Address - Phone:901-837-7359
Mailing Address - Fax:901-837-7359
Practice Address - Street 1:529 WILLIAMSBURG DR
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:TN
Practice Address - Zip Code:38004-7893
Practice Address - Country:US
Practice Address - Phone:901-837-7359
Practice Address - Fax:901-837-7359
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18249363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health