Individual
MR. DALE MICHAEL SANDERSON
Active
Individual
MR. DALE MICHAEL SANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
N.P.
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
AP06807
LA
363LN0000X
Neonatal Nurse Practitioner
TAP002754
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2190598
—
LA
01
—
PENDING
BCBS LA
LA
Enumeration date
01/31/2012
Last updated
10/08/2020
Update your record
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