Provider Demographics
NPI:1124463518
Name:SANDERS, CARRIE M (PA)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:M
Last Name:SANDERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2120 N MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-2221
Mailing Address - Country:US
Mailing Address - Phone:972-438-4636
Mailing Address - Fax:214-260-0953
Practice Address - Street 1:2120 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2221
Practice Address - Country:US
Practice Address - Phone:972-438-4636
Practice Address - Fax:214-260-0953
Is Sole Proprietor?:No
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA01435363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical