Provider Demographics
NPI:1295151025
Name:SANDBERG, CRAIG S (CRNA)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:S
Last Name:SANDBERG
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 OSAGE ST
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NE
Mailing Address - Zip Code:69162-1714
Mailing Address - Country:US
Mailing Address - Phone:308-254-5825
Mailing Address - Fax:308-254-7258
Practice Address - Street 1:645 OSAGE ST
Practice Address - Street 2:SIDNEY REGIONAL MEDICAL CENTER
Practice Address - City:SIDNEY
Practice Address - State:NE
Practice Address - Zip Code:69162-1714
Practice Address - Country:US
Practice Address - Phone:308-254-5825
Practice Address - Fax:308-254-7258
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5128498-4406367500000X
UT5128498-8901367500000X
NE101254367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered