Healthcare Provider Details

I. General information

NPI: 1710104229
Provider Name (Legal Business Name): SARAH L BRUNER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 S MILL AVE STE D12
TEMPE AZ
85282
US

IV. Provider business mailing address

5030 S MILL AVE STE D12
TEMPE AZ
85282-6849
US

V. Phone/Fax

Practice location:
  • Phone: 480-894-2823
  • Fax: 480-756-6663
Mailing address:
  • Phone: 480-894-2823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTAP11419
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: