Provider Demographics
NPI:1255050167
Name:WOLFE, SARA JANE (APRN)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:JANE
Last Name:WOLFE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:JANE
Other - Last Name:WOLFE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:11404 W DODGE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2511
Mailing Address - Country:US
Mailing Address - Phone:402-210-1031
Mailing Address - Fax:
Practice Address - Street 1:11404 W DODGE RD STE 300
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2511
Practice Address - Country:US
Practice Address - Phone:402-209-4782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE64741163WP0808X
NE114559363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health