Provider Demographics
NPI:1982705224
Name:BRUMMET, SANDRA J (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:BRUMMET
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:J
Other - Last Name:KLEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1658 N MILWAUKEE AVE # 100-1767
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-6905
Mailing Address - Country:US
Mailing Address - Phone:217-652-0169
Mailing Address - Fax:
Practice Address - Street 1:1211 CORTINA DR
Practice Address - Street 2:
Practice Address - City:ORLAND
Practice Address - State:CA
Practice Address - Zip Code:95963-1699
Practice Address - Country:US
Practice Address - Phone:530-865-5544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-000577363LF0000X
CA95003586363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
K21505Medicare ID - Type Unspecified
P43682Medicare UPIN