Provider Demographics
NPI:1902061930
Name:SMALL SANDERS, SHAWN RENEA (ANPBC)
Entity Type:Individual
Prefix:MRS
First Name:SHAWN
Middle Name:RENEA
Last Name:SMALL SANDERS
Suffix:
Gender:F
Credentials:ANPBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SAM PERRY BLVD
Mailing Address - Street 2:MARY WASHINGTON HOSPITAL
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406
Mailing Address - Country:US
Mailing Address - Phone:540-741-1323
Mailing Address - Fax:
Practice Address - Street 1:1000 SAM PERRY BLVD
Practice Address - Street 2:MARY WASHINGTON HOSPITAL
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22406
Practice Address - Country:US
Practice Address - Phone:540-741-1323
Practice Address - Fax:540-741-7263
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167547363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1902061930OtherOPTIMA
VA305008OtherKAISER
VA1902061930Medicaid
VA540896390OtherTRICARE
VA1902061930Medicare PIN