Provider Demographics
NPI:1710281563
Name:BRUNEY, SARAH SUZANNE (NP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:SUZANNE
Last Name:BRUNEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:S
Other - Last Name:FREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1501 WATERFORD PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-9631
Mailing Address - Country:US
Mailing Address - Phone:989-534-2370
Mailing Address - Fax:989-534-2371
Practice Address - Street 1:1501 WATERFORD PKWY STE B
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-9631
Practice Address - Country:US
Practice Address - Phone:989-534-2370
Practice Address - Fax:989-534-2371
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704280113363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1710281563Medicaid
MI0M61830063Medicare PIN