Provider Demographics
NPI:1063214849
Name:SANDER, KARISSA KAY
Entity type:Individual
Prefix:MRS
First Name:KARISSA
Middle Name:KAY
Last Name:SANDER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 31ST ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-8163
Mailing Address - Country:US
Mailing Address - Phone:402-563-7070
Mailing Address - Fax:402-563-7072
Practice Address - Street 1:2200 31ST ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-8163
Practice Address - Country:US
Practice Address - Phone:402-563-7070
Practice Address - Fax:402-563-7072
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18914164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse