Provider Demographics
NPI:1760451397
Name:BRANDENBURG, SHERRI ANN (RN)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:ANN
Last Name:BRANDENBURG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHERRI
Other - Middle Name:ANN
Other - Last Name:LAHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2702 BOXWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-7305
Mailing Address - Country:US
Mailing Address - Phone:920-445-4452
Mailing Address - Fax:
Practice Address - Street 1:2702 BOXWOOD CIR
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-7305
Practice Address - Country:US
Practice Address - Phone:920-445-4452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2016-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI138923-030163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management