Individual
MRS. LAVONNA K SANDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1202 N MUSKOGEE PL, CLAREMORE, OK 74017-3058
(918) 341-2556
(918) 342-2304
Mailing address
9900 E 570 RD, CATOOSA, OK 74015-6294
(918) 344-0807
(918) 266-0170
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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