Provider Demographics
NPI:1346435054
Name:SUBLETT-ADAMS, SONIA A (APRN)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:A
Last Name:SUBLETT-ADAMS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2608 S 158TH PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-1704
Mailing Address - Country:US
Mailing Address - Phone:402-578-5353
Mailing Address - Fax:402-715-5040
Practice Address - Street 1:11912 ELM ST STE 22
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4363
Practice Address - Country:US
Practice Address - Phone:402-578-5353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF-118125363LW0102X
NE110896363LX0001X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025486000Medicaid
NE47068731746Medicaid
NE47-0391517-14Medicaid
NE10025350400Medicaid
IA1346435054Medicaid
NE47068731799Medicaid
NE47068731795Medicaid