Individual
MRS. LAVONNA K SANDERS
Active
Individual
MRS. LAVONNA K SANDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R49134
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100783920A
—
OK
01
—
1285810051
MEDICARE GROUP PIN
OK
Enumeration date
08/16/2006
Last updated
04/05/2012
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