Provider Demographics
NPI:1679258404
Name:SANNER, MARCY ANNE
Entity type:Individual
Prefix:MS
First Name:MARCY
Middle Name:ANNE
Last Name:SANNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 BRIDGE BLVD SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-3736
Mailing Address - Country:US
Mailing Address - Phone:505-205-4906
Mailing Address - Fax:
Practice Address - Street 1:1104 BRIDGE BLVD SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-3736
Practice Address - Country:US
Practice Address - Phone:505-205-4906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician