Provider Demographics
NPI:1447903802
Name:SANDERS, GINA MARIE (CPT)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 MCKEEN ST
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76704-2138
Mailing Address - Country:US
Mailing Address - Phone:254-227-0075
Mailing Address - Fax:
Practice Address - Street 1:4509 BELLMEAD DR
Practice Address - Street 2:
Practice Address - City:BELLMEAD
Practice Address - State:TX
Practice Address - Zip Code:76705-2605
Practice Address - Country:US
Practice Address - Phone:254-424-9444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty