Provider Demographics
NPI:1932913506
Name:PETERSON, SANDRA SUE
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:SUE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5631 ABBEY CT APT 17
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-3310
Mailing Address - Country:US
Mailing Address - Phone:308-627-0161
Mailing Address - Fax:
Practice Address - Street 1:5631 ABBEY CT APT 17
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-3310
Practice Address - Country:US
Practice Address - Phone:308-627-0161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider