| Doctor Name: | SANDRA A. BOERNER |
| NPI Number: | 1093099269 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APNP |
| License Number: | 4634-33 |
| Business Practice Address: | N143w6515 Pioneer Rd Cedarburg, WI - 530122705 |
| Business Phone Number: | 2623776933 |
| Business Fax Number: | 2623762495 |
| Mailing Address: | 4425 N Port Washington Rd, Attn: Csmcp Clinic Credentialing GLENDALE |
| State: | WI |
| Postal Code: | 532121082 |
| Phone Number: | 2623776933 |
| Fax Number: | 2623762495 |
| NPI Enumeration Date: | 10/05/2011 |
| NPI Last Update Date: | 11/16/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 4634-33 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |