Individual
MR. ETHAN A SANDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
2300 N EDWARD ST, DECATUR, IL 62526-4192
(217) 876-8121
Mailing address
2300 N EDWARD ST STE 2400, DECATUR, IL 62526-4192
(217) 876-2400
(217) 876-2405
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
209.033959
IL
363LG0600X
Gerontology Nurse Practitioner
209.033959
IL
Other
Enumeration date
11/13/2025
Last updated
12/01/2025
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