Provider Demographics
NPI:1417305384
Name:DOLEZAL, SARAH (PA-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:DOLEZAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:JANAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1500 S 48TH ST STE 800
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1200
Mailing Address - Country:US
Mailing Address - Phone:402-483-8600
Mailing Address - Fax:402-483-8689
Practice Address - Street 1:1500 S 48TH ST STE 800
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1200
Practice Address - Country:US
Practice Address - Phone:402-483-8600
Practice Address - Fax:402-483-8689
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026945301Medicaid