Provider Demographics
NPI:1780476440
Name:BENNETT, SANDRA
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9679 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-8213
Mailing Address - Country:US
Mailing Address - Phone:402-366-3067
Mailing Address - Fax:
Practice Address - Street 1:3425 36TH RD
Practice Address - Street 2:
Practice Address - City:SILVER CREEK
Practice Address - State:NE
Practice Address - Zip Code:68663-3704
Practice Address - Country:US
Practice Address - Phone:308-773-2519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion