Provider Demographics
NPI:1598240756
Name:STICKROD, SANDI
Entity Type:Individual
Prefix:
First Name:SANDI
Middle Name:
Last Name:STICKROD
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 1:3520 MAPLEWOOD BLVD BLDG 3520
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-4562
Mailing Address - Country:US
Mailing Address - Phone:402-572-9005
Mailing Address - Fax:
Practice Address - Street 1:3520 MAPLEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-4562
Practice Address - Country:US
Practice Address - Phone:402-572-9005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE75246163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool