Provider Demographics
NPI:1023839701
Name:SPORLEDER, DEA DEA RENAE
Entity type:Individual
Prefix:
First Name:DEA DEA
Middle Name:RENAE
Last Name:SPORLEDER
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 1:5606 S 147TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-2648
Mailing Address - Country:US
Mailing Address - Phone:402-715-8200
Mailing Address - Fax:
Practice Address - Street 1:5606 S 147TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2648
Practice Address - Country:US
Practice Address - Phone:402-715-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide