Provider Demographics
NPI:1255705851
Name:BRUMMETT, SANDRA LEE (FNP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:BRUMMETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SANRA
Other - Middle Name:LEE
Other - Last Name:TEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1343 N ALMA SCHOOL RD
Mailing Address - Street 2:STE 160
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5901
Mailing Address - Country:US
Mailing Address - Phone:480-963-1853
Mailing Address - Fax:480-963-1854
Practice Address - Street 1:7233 E BASELINE ROAD STE 126
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209
Practice Address - Country:US
Practice Address - Phone:480-699-2222
Practice Address - Fax:480-699-3033
Is Sole Proprietor?:No
Enumeration Date:2015-11-19
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZF1015665363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily