Healthcare Provider Details

I. General information

NPI: 1295151025
Provider Name (Legal Business Name): CRAIG S SANDBERG CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2014
Last Update Date: 11/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 OSAGE ST SIDNEY REGIONAL MEDICAL CENTER
SIDNEY NE
69162-1714
US

IV. Provider business mailing address

645 OSAGE ST
SIDNEY NE
69162-1714
US

V. Phone/Fax

Practice location:
  • Phone: 308-254-5825
  • Fax: 308-254-7258
Mailing address:
  • Phone: 308-254-5825
  • Fax: 308-254-7258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number5128498-4406
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number5128498-8901
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number101254
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: