Healthcare Provider Details

I. General information

NPI: 1710022744
Provider Name (Legal Business Name): SANDRA LUJEAN BRUNKEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMR 442, BOX 886
APO AE
09042
US

IV. Provider business mailing address

CMR 442, BOX 886
APO AE
09042
US

V. Phone/Fax

Practice location:
  • Phone: 0114962216530886
  • Fax: 011496221173335
Mailing address:
  • Phone: 0114962216530886
  • Fax: 011496221173335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number26331
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN00085601
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: