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General NPI Number Information
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NPI Number | 1629224282
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Entity Type | Individual
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Provider Name | MARGARET MARY SASSE-WALLACE RDMS
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Gender | Female
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Dates
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Enumeration Date | 08/14/2008
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Last Update Date | 08/14/2008
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Provider Practice Location Address
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Address Line | 1942 US HIGHWAY 20
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City | GORDON
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State | NE
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Zip | 69343-5400
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Country | US
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Telephone | 308-282-1599
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Fax |
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Provider Business Mailing Address
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Address Line | 1942 US HIGHWAY 20
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City | GORDON
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State | NE
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Zip | 69343-5400
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Country | US
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Telephone | 308-282-1599
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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 | 247100000X
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Taxonomy Name | Radiologic Technologist
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License Number | 267969
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2471M2300X
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Taxonomy Name | Mammography Radiologic Technologist
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License Number | 267969
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2471S1302X
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Taxonomy Name | Sonography Radiologic Technologist
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License Number | 81596
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2471V0105X
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Taxonomy Name | Vascular Sonography Radiologic Technologist
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License Number | 81596
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License Number State |
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