Provider Demographics
NPI:1962215194
Name:SACK, PATRICIA
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:SACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DAISY
Other - Middle Name:PATRICIA
Other - Last Name:NOVOA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26 CYPRESS STREET
Mailing Address - Street 2:PATRICIA SACK
Mailing Address - City:YUTAN
Mailing Address - State:NE
Mailing Address - Zip Code:68073
Mailing Address - Country:US
Mailing Address - Phone:402-840-8917
Mailing Address - Fax:
Practice Address - Street 1:26 CYPRESS ST
Practice Address - Street 2:
Practice Address - City:YUTAN
Practice Address - State:NE
Practice Address - Zip Code:68073-3011
Practice Address - Country:US
Practice Address - Phone:402-840-8917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE268492093747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant