Healthcare Provider Details

I. General information

NPI: 1457240095
Provider Name (Legal Business Name): SANDRA LEA BJORNSTAD RN, OMS, WCC, DWC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11101 N SHERMAN RD
EDGERTON WI
53534-9002
US

IV. Provider business mailing address

3868 REDSTONE DR
JANESVILLE WI
53548-5841
US

V. Phone/Fax

Practice location:
  • Phone: 608-884-3441
  • Fax:
Mailing address:
  • Phone: 608-754-9216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number115364-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: