Healthcare Provider Details

I. General information

NPI: 1215406061
Provider Name (Legal Business Name): SONDRA R HEPBURN LPN, ADMINISTRATOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SONDRA R DOTY

II. Dates (important events)

Enumeration Date: 11/21/2018
Last Update Date: 11/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 N 66TH ST
LINCOLN NE
68505-2481
US

IV. Provider business mailing address

451 N 66TH ST
LINCOLN NE
68505-2481
US

V. Phone/Fax

Practice location:
  • Phone: 402-486-3130
  • Fax: 402-486-3123
Mailing address:
  • Phone: 402-486-3130
  • Fax: 402-486-3123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number5906
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: