Provider Demographics
NPI:1386613552
Name:BREWER, SANDRA D (CRNP)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:D
Last Name:BREWER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:E
Other - Last Name:BRUNK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:1 GUTHRIE SQ
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1625
Practice Address - Country:US
Practice Address - Phone:570-888-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP004945C363L00000X
NYF304302-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACC9269OtherRR MEDICARE GROUP
PAP00316311OtherRR MEDICARE PIN
NYP00319054OtherRR MEDICARE PIN
PAGU039853OtherMEDICARE GROUP
NY02703506Medicaid
NYCC8362OtherRR MEDICARE GROUP
NYRB0037Medicare PIN
PAGU039853OtherMEDICARE GROUP