Healthcare Provider Details
I. General information
NPI: 1952531055
Provider Name (Legal Business Name): SANDRA LEE DOERNEMANN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 07/23/2009
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1721 COLFAX ST
SCHUYLER NE
68661-1400
US
IV. Provider business mailing address
1721 COLFAX ST
SCHUYLER NE
68661-1400
US
V. Phone/Fax
- Phone: 402-352-3745
- Fax: 402-352-8750
- Phone: 402-352-3745
- Fax: 402-352-8750
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363L00000X |
| Taxonomy | Nurse Practitioner |
| License Number | 111055 |
| License Number State | NE |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: