Provider Demographics
NPI:1790566800
Name:SANDOZ, RILEY NICOLE JR (PP)
Entity Type:Individual
Prefix:MISS
First Name:RILEY
Middle Name:NICOLE
Last Name:SANDOZ
Suffix:JR
Gender:F
Credentials:PP
Other - Prefix:MISS
Other - First Name:RILEY
Other - Middle Name:NIKOLE
Other - Last Name:SANDOZ
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:PP
Mailing Address - Street 1:80592 MITCHELL SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:NE
Mailing Address - Zip Code:69357-1942
Mailing Address - Country:US
Mailing Address - Phone:308-765-2041
Mailing Address - Fax:
Practice Address - Street 1:80592 MITCHELL SOUTH RD
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:NE
Practice Address - Zip Code:69357-1942
Practice Address - Country:US
Practice Address - Phone:308-765-2041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool