1730474156 NPI number — CLARESSA LAJUNE SANDERS JONES CRNP

Table of content: CLARESSA LAJUNE SANDERS JONES CRNP (NPI 1730474156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730474156 NPI number — CLARESSA LAJUNE SANDERS JONES CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANDERS JONES
Provider First Name:
CLARESSA
Provider Middle Name:
LAJUNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SANDERS
Provider Other First Name:
CLARESSA
Provider Other Middle Name:
LAJUNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730474156
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
904 ANNA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUSCALOOSA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35401-2014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-345-6960
Provider Business Mailing Address Fax Number:
205-342-3373

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
535 JACK WARNER PKWY NE
Provider Second Line Business Practice Location Address:
SUITE K
Provider Business Practice Location Address City Name:
TUSCALOOSA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35404-5751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-758-6471
Provider Business Practice Location Address Fax Number:
205-758-6472
Provider Enumeration Date:
06/14/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  1-108168 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CRNP RX # 3241 . This is a "ALABAMA BOARD OF NURSING" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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