Provider Information for 1831767359
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AMANDA SANDERS LAC
Sex: Female
NPI: 1831767359
Last Updated: 2021-06-11
Certification Date: 2021-06-11
Certification Date: 2021-06-11
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1831767359 | ||||||||
| Enumeration Date | 2021-06-11 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | PO BOX 2109 RUSSELLVILLE, AR 72811-2109 United States Phone: 479-967-2322 | Fax:479-967-2876 | ||||||||
| Primary Practice Address | 2403 MAIN DR FAYETTEVILLE, AR 72704-5223 United States Phone: 479-967-2322 | Fax:479-967-2876 | ||||||||
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