1346435054 NPI number — SONIA A SUBLETT-ADAMS APRN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346435054 NPI number — SONIA A SUBLETT-ADAMS APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUBLETT-ADAMS
Provider First Name:
SONIA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
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:
1346435054
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17525 GOLD PLZ STE 104
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:
68130-5607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-819-9446
Provider Business Mailing Address Fax Number:
402-715-5040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17525 GOLD PLZ STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68130-5607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-819-9446
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/06/2007

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: 363LW0102X , with the licence number:  F-118125 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LX0001X , with the licence number: 110896 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LW0102X , with the licence number: 110896 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1346435054 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 47068731746 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025350400 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025486000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 47-0391517-14 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 47068731799 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 47068731795 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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