Provider Demographics
NPI:1396924098
Name:SANDERS, STEPHANIE RENEE (LPN)
Entity type:Individual
Prefix:PROF
First Name:STEPHANIE
Middle Name:RENEE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-1111
Mailing Address - Country:US
Mailing Address - Phone:937-417-1090
Mailing Address - Fax:
Practice Address - Street 1:1103 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-1111
Practice Address - Country:US
Practice Address - Phone:937-417-1090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH125170164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse