Provider Demographics
NPI:1518746742
Name:SANDERS, DALTON (DNP, MBA, CRNA, APRN)
Entity type:Individual
Prefix:DR
First Name:DALTON
Middle Name:
Last Name:SANDERS
Suffix:
Gender:M
Credentials:DNP, MBA, CRNA, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 JASON AVE
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:MO
Mailing Address - Zip Code:63965-7277
Mailing Address - Country:US
Mailing Address - Phone:573-450-8368
Mailing Address - Fax:
Practice Address - Street 1:3100 OAK GROVE RD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-1573
Practice Address - Country:US
Practice Address - Phone:573-776-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025019587367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered