Healthcare Provider Details

I. General information

NPI: 1346435054
Provider Name (Legal Business Name): SONIA A SUBLETT-ADAMS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17525 GOLD PLZ STE 104
OMAHA NE
68130-5607
US

IV. Provider business mailing address

17525 GOLD PLZ STE 104
OMAHA NE
68130-5607
US

V. Phone/Fax

Practice location:
  • Phone: 402-819-9446
  • Fax:
Mailing address:
  • Phone: 402-819-9446
  • Fax: 402-715-5040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberF-118125
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number110896
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number110896
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: