Provider Information for 1184105967
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MARY BETH SANDERS
Sex: Female
NPI: 1184105967
Last Updated: 2018-08-28
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1184105967 | ||||||||||||
| Enumeration Date | 2018-08-28 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 10348 PARK RD CHARLOTTE, NC 28210-8507 United States Phone: 704-288-1097 | Fax: | ||||||||||||
| Primary Practice Address | 10348 PARK RD CHARLOTTE, NC 28210-8507 United States Phone: 704-288-1097 | Fax: | ||||||||||||
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