Provider Demographics
NPI:1215406061
Name:HEPBURN, SONDRA R (LPN, ADMINISTRATOR)
Entity Type:Individual
Prefix:
First Name:SONDRA
Middle Name:R
Last Name:HEPBURN
Suffix:
Gender:F
Credentials:LPN, ADMINISTRATOR
Other - Prefix:
Other - First Name:SONDRA
Other - Middle Name:R
Other - Last Name:DOTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:451 N 66TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2481
Mailing Address - Country:US
Mailing Address - Phone:402-486-3130
Mailing Address - Fax:402-486-3123
Practice Address - Street 1:451 N 66TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2481
Practice Address - Country:US
Practice Address - Phone:402-486-3130
Practice Address - Fax:402-486-3123
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5906164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse