Healthcare Provider Details

I. General information

NPI: 1558329292
Provider Name (Legal Business Name): SHIRLEY JOANNE SANDERS NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHIRLEY JOANNE BRUENJES FNP

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3203 MIDDLE ROAD
COLUMBUS IN
47203-4427
US

IV. Provider business mailing address

806 JACKSON ST
COLUMBUS IN
47201-6264
US

V. Phone/Fax

Practice location:
  • Phone: 812-373-2700
  • Fax: 812-373-2710
Mailing address:
  • Phone: 812-748-3412
  • Fax: 812-377-6024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71000212
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: