Provider Demographics
NPI:1174544902
Name:BREHMER, SANDRA G (APRN, FNP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:G
Last Name:BREHMER
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2559
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-2559
Mailing Address - Country:US
Mailing Address - Phone:843-764-0194
Mailing Address - Fax:843-875-3149
Practice Address - Street 1:709 TROLLEY RD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-5203
Practice Address - Country:US
Practice Address - Phone:843-764-0194
Practice Address - Fax:843-875-3149
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2117363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0810Medicaid
SCGP3659OtherMEDICAID GROUP #
SCAA05757819Medicare PIN
Q21340Medicare UPIN
SCGP3659OtherMEDICAID GROUP #
SCP00871888Medicare PIN
SCAA05757126Medicare PIN