Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 2018 | NE |
NPI | 1023668902 |
---|---|
Provider Name | Mrs. Sarah Jean Placke |
First Address | Saint Libory, NE 68872-3214 |
Second Address | Grand Island, NE 68803-4910 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2019 |
Last Update Date | 21/11/2020 |