Provider Demographics
NPI:1285724054
Name:SANBORN, JANE ELIZABETH (PA)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:ELIZABETH
Last Name:SANBORN
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 1:5705 COUNTRY FOREST DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-4458
Mailing Address - Country:US
Mailing Address - Phone:919-601-4415
Mailing Address - Fax:
Practice Address - Street 1:4201 LAKE BOONE TRL
Practice Address - Street 2:SUITE 202
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7512
Practice Address - Country:US
Practice Address - Phone:919-235-0050
Practice Address - Fax:919-235-0505
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001000401363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89013NAMedicaid
NC89013NAMedicaid