Provider Demographics
NPI:1548686546
Name:SANDERS, DENISE (RTR)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:RTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3012 YUKON AVE N
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55427-2524
Mailing Address - Country:US
Mailing Address - Phone:952-451-2852
Mailing Address - Fax:
Practice Address - Street 1:3012 YUKON AVE N
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55427-2524
Practice Address - Country:US
Practice Address - Phone:952-451-2852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN229327247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist