Provider Demographics
NPI:1710022744
Name:BRUNKEN, SANDRA LUJEAN (RN)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:LUJEAN
Last Name:BRUNKEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 442, BOX 886
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09042
Mailing Address - Country:US
Mailing Address - Phone:011496221-653-0886
Mailing Address - Fax:01149622-117-3335
Practice Address - Street 1:CMR 442, BOX 886
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09042
Practice Address - Country:US
Practice Address - Phone:011496221-653-0886
Practice Address - Fax:01149622-117-3335
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE26331163WA2000X
WARN00085601163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WA2000XNursing Service ProvidersRegistered NurseAdministrator