Provider Demographics
NPI:1861225419
Name:SANDERS, JASON DREW (RN)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:DREW
Last Name:SANDERS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 PEGER RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-5484
Mailing Address - Country:US
Mailing Address - Phone:907-455-9737
Mailing Address - Fax:
Practice Address - Street 1:3180 PEGER RD
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-5484
Practice Address - Country:US
Practice Address - Phone:907-455-9737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK215106163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK215106OtherALASKA BOARD OF NURSING