Provider Demographics
NPI:1417745779
Name:BONGERS, SANDRA KAY
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAY
Last Name:BONGERS
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 1:1851 30 RD
Mailing Address - Street 2:
Mailing Address - City:BRAINARD
Mailing Address - State:NE
Mailing Address - Zip Code:68626-3039
Mailing Address - Country:US
Mailing Address - Phone:402-367-7781
Mailing Address - Fax:
Practice Address - Street 1:1851 30 RD
Practice Address - Street 2:
Practice Address - City:BRAINARD
Practice Address - State:NE
Practice Address - Zip Code:68626-3039
Practice Address - Country:US
Practice Address - Phone:402-367-7781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion