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General NPI Number Information
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NPI Number | 1023668902
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Entity Type | Individual
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Provider Name | SARAH JEAN PLACKE RDH
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Gender | Female
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Dates
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Enumeration Date | 09/12/2019
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Last Update Date | 11/21/2020
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Provider Practice Location Address
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Address Line | 425 N DIERS AVE
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City | GRAND ISLAND
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State | NE
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Zip | 68803-4910
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Country | US
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Telephone | 308-381-4452
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Fax |
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Provider Business Mailing Address
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Address Line | 512 HARDY RD
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City | SAINT LIBORY
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State | NE
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Zip | 68872-3214
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Country | US
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Telephone | 308-991-1818
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 2018
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License Number State | NE
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