MEDICARE: SANDRA SUE PAVELKA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1558667766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA SUE PAVELKA

Provider Business Mailing Address
First Line	:	2935 PINE LAKE RD STE F
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68516-6009
Country	:	US
Telephone Number	:	402-261-4017
Fax Number	:

Provider Business Practice Location Address
First Line	:	2935 PINE LAKE RD STE F
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68516-6009
Country	:	US
Telephone Number	:	402-261-4017
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2011
Last Update Date	:	01/06/2014

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Directions to “ SANDRA SUE PAVELKA ” Practice Location

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