Individual
JENNA NICOLE SANDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2051 CLEVIDENCE BLVD STE C, CLARKSVILLE, IN 47129-2278
(812) 280-6623
(812) 280-6627
Mailing address
PO BOX 776879, CHICAGO, IL 60677-6879
(502) 588-9490
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01073708A
IN
208000000X
Pediatrics Physician
47001
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201249990
—
IN
05
—
7100212230
—
KY
01
—
K298210
MEDICARE
KY
Enumeration date
03/21/2011
Last updated
02/09/2023
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