Healthcare Provider Details

I. General information

NPI: 1790821882
Provider Name (Legal Business Name): SANDRA LYNN BERNKLAU APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 NE NEFF RD STE 302
BEND OR
97701-4279
US

IV. Provider business mailing address

4507 DEYO AVE
BROOKFIELD IL
60513-2217
US

V. Phone/Fax

Practice location:
  • Phone: 541-706-4220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP70054411
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209006230
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: