Basic Information
| Provider Information | |||||||||
| NPI: | 1093099269 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOERNER | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | APNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1311 N PORT WASHINGTON RD, RM 121 | ||||||||
| Address2: | ATTN: PALLIATIVE CARE PROGRAM | ||||||||
| City: | MEQUON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53097 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2622438453 | ||||||||
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| Practice Location | |||||||||
| Address1: | N143W6515 PIONEER RD | ||||||||
| Address2: | |||||||||
| City: | CEDARBURG | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530122705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2623776933 | ||||||||
| FaxNumber: | 2623762495 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2011 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 4634-33 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.