Healthcare Provider Details

I. General information

NPI: 1538194782
Provider Name (Legal Business Name): SANDRA M HENRY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1659 WASHINGTON ST
BLAIR NE
68008-1655
US

IV. Provider business mailing address

1659 WASHINGTON ST
BLAIR NE
68008-1655
US

V. Phone/Fax

Practice location:
  • Phone: 420-533-2223
  • Fax: 402-301-6272
Mailing address:
  • Phone: 402-533-2223
  • Fax: 402-301-6272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number498
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: