Basic Information
| Provider Information | |||||||||
| NPI: | 1255705851 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRUMMETT | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | FNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | TEAL | ||||||||
| OtherFirstName: | SANRA | ||||||||
| OtherMiddleName: | LEE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1343 N ALMA SCHOOL RD | ||||||||
| Address2: | STE 160 | ||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852245901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809631853 | ||||||||
| FaxNumber: | 4809631854 | ||||||||
| Practice Location | |||||||||
| Address1: | 7233 E BASELINE ROAD STE 126 | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806992222 | ||||||||
| FaxNumber: | 4806993033 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2015 | ||||||||
| LastUpdateDate: | 04/21/2017 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F1015665 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.