Provider Demographics
NPI:1629759113
Name:HOMAN, SALLY (PA)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:HOMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1511 GRAFTON DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68850-1115
Mailing Address - Country:US
Mailing Address - Phone:308-325-3257
Mailing Address - Fax:
Practice Address - Street 1:1336 W A ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68522-1231
Practice Address - Country:US
Practice Address - Phone:402-314-3399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant