Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003164641 |
---|---|
Provider Name | Amber Sandoe |
First Address | Juniata, NE 68955-0273 |
Second Address | Omaha, NE 68117-2807 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2012 |
Last Update Date | 28/08/2012 |