Healthcare Provider Details

I. General information

NPI: 1285684647
Provider Name (Legal Business Name): SANDRA LLOYD P.A.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4333 S 86TH ST
LINCOLN NE
68526-9260
US

IV. Provider business mailing address

4333 S 86TH ST
LINCOLN NE
68526-9260
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-8500
  • Fax: 402-483-8500
Mailing address:
  • Phone: 402-483-8500
  • Fax: 402-483-8501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number575
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: