Healthcare Provider Details

I. General information

NPI: 1023668902
Provider Name (Legal Business Name): SARAH JEAN PLACKE RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2019
Last Update Date: 11/21/2020
Certification Date: 11/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 N DIERS AVE
GRAND ISLAND NE
68803-4910
US

IV. Provider business mailing address

512 HARDY RD
SAINT LIBORY NE
68872-3214
US

V. Phone/Fax

Practice location:
  • Phone: 308-381-4452
  • Fax:
Mailing address:
  • Phone: 308-991-1818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2018
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: