1629150669 NPI number — SANDRA ELAINE LEADERS F.N.P.

Table of content: (NPI 1316820194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629150669 NPI number — SANDRA ELAINE LEADERS F.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEADERS
Provider First Name:
SANDRA
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
F.N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629150669
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3755
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68103-0755
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-354-2100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 EBAUGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENWOOD
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51534-1811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-527-5204
Provider Business Practice Location Address Fax Number:
712-527-9346
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP2300X , with the licence number:  A071752 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: A1071752 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0638593 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0254656 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1629150669 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 47068731712 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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