Provider Demographics
NPI:1699035956
Name:KUEFNER, SANDRA RULON (NP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:RULON
Last Name:KUEFNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:RULON
Other - Last Name:HICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:05/25/1959
Mailing Address - Street 1:358 GARDEN CITY ST
Mailing Address - Street 2:
Mailing Address - City:ISLIP TERRACE
Mailing Address - State:NY
Mailing Address - Zip Code:11752-2519
Mailing Address - Country:US
Mailing Address - Phone:631-680-9615
Mailing Address - Fax:
Practice Address - Street 1:216 1ST ST
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3901
Practice Address - Country:US
Practice Address - Phone:516-741-0570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305480-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health