Healthcare Provider Details

I. General information

NPI: 1770789737
Provider Name (Legal Business Name): JESSICA MARIE SANDMEIER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9110 ANDERMATT DR STE 2
LINCOLN NE
68526-6701
US

IV. Provider business mailing address

9110 ANDERMATT DR STE 2
LINCOLN NE
68526-6701
US

V. Phone/Fax

Practice location:
  • Phone: 402-484-3199
  • Fax: 402-484-3196
Mailing address:
  • Phone: 402-483-7641
  • Fax: 402-483-0527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number3968
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number1038
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: