Provider Demographics
NPI:1598642332
Name:SANFORD, GINA MARIE (APRN)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:SANFORD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:PANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3755
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0755
Mailing Address - Country:US
Mailing Address - Phone:402-354-2100
Mailing Address - Fax:402-354-2155
Practice Address - Street 1:2540 N HEALTHY WAY
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2315
Practice Address - Country:US
Practice Address - Phone:402-727-7796
Practice Address - Fax:402-727-9574
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE116252363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner