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General NPI Number Information
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NPI Number | 1053799940
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Entity Type | Individual
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Provider Name | SARA BRANDAL APN
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Gender | Female
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Dates
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Enumeration Date | 05/11/2015
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Last Update Date | 06/28/2024
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Provider Practice Location Address
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Address Line | 21029 W MAIN ST STE 102
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City | BUCKEYE
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State | AZ
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Zip | 85396-3527
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Country | US
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Telephone | 623-248-6404
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Fax | 623-213-8541
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Provider Business Mailing Address
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Address Line | 15311 S 182ND LN
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City | GOODYEAR
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State | AZ
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Zip | 85338-3644
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Country | US
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Telephone | 630-400-3559
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209012507
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 230931
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License Number State | AZ
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