Provider Demographics
NPI:1093099269
Name:BOERNER, SANDRA A (APNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:A
Last Name:BOERNER
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 N PORT WASHINGTON RD, RM 121
Mailing Address - Street 2:ATTN: PALLIATIVE CARE PROGRAM
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53097
Mailing Address - Country:US
Mailing Address - Phone:262-243-8453
Mailing Address - Fax:
Practice Address - Street 1:N143W6515 PIONEER RD
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-2705
Practice Address - Country:US
Practice Address - Phone:262-377-6933
Practice Address - Fax:262-376-2495
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4634-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily