Healthcare Provider Details

I. General information

NPI: 1881115723
Provider Name (Legal Business Name): BRANDON MARIE SALE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2017
Last Update Date: 06/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2231 JORDAN AVE
JUNEAU AK
99801-8050
US

IV. Provider business mailing address

2231 JORDAN AVE
JUNEAU AK
99801-8050
US

V. Phone/Fax

Practice location:
  • Phone: 907-789-1812
  • Fax:
Mailing address:
  • Phone: 334-796-6969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number124160
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number123047
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number129495
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: