Provider Demographics
NPI:1285102293
Name:SANDER, ANDREA (MSN, RN)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:SANDER
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:RYKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, RN
Mailing Address - Street 1:19883 12TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370
Mailing Address - Country:US
Mailing Address - Phone:253-640-3474
Mailing Address - Fax:
Practice Address - Street 1:19883 12TH AVE NE
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370
Practice Address - Country:US
Practice Address - Phone:253-640-3474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00101321163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health