Provider Demographics
NPI:1184142085
Name:SAUERBRUNN, CANDICE MARIE (RN)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:MARIE
Last Name:SAUERBRUNN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S GREEN ST
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:IL
Mailing Address - Zip Code:62906-1126
Mailing Address - Country:US
Mailing Address - Phone:618-833-8022
Mailing Address - Fax:618-833-6535
Practice Address - Street 1:301 S GREEN ST
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:IL
Practice Address - Zip Code:62906-1126
Practice Address - Country:US
Practice Address - Phone:618-833-8022
Practice Address - Fax:618-833-6535
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-404284163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool