Provider Demographics
NPI:1114368172
Name:BIRKENHAUER, SANDRA (RN, CPNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:BIRKENHAUER
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:825 ADAMS ST APT 4B
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-2191
Mailing Address - Country:US
Mailing Address - Phone:201-406-1771
Mailing Address - Fax:
Practice Address - Street 1:670 N BEERS ST BLDG 4
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1527
Practice Address - Country:US
Practice Address - Phone:732-335-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-07
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR15538600163W00000X
NJ26NJ00544700363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse