Provider Demographics
NPI:1972795540
Name:BRUNNER, SANDRA LYNN (CNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:BRUNNER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LYNN
Other - Last Name:HENSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2525 WAYNE MADISON RD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:OH
Mailing Address - Zip Code:45067-9768
Mailing Address - Country:US
Mailing Address - Phone:513-844-4643
Mailing Address - Fax:513-844-4248
Practice Address - Street 1:2525 WAYNE MADISON RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:OH
Practice Address - Zip Code:45067-9768
Practice Address - Country:US
Practice Address - Phone:513-844-4643
Practice Address - Fax:513-844-4248
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN174304163W00000X
OHNP07408363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse