Active NPI
Stacie Sandall
- Day Training/Habilitation Specialist
- MC Cook, NE
National Provider Identifier
1730997396
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Day Training/Habilitation Specialist
- License
- 54739511
- Practice address
- 110 E E St
MC Cook, NE 69001-2049 - Phone
- (308) 340-1165
- NPI assigned
- Dec 27, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Day Training/Habilitation Specialist | 373H00000X | 54739511 | NE | Primary |
Addresses
Primary practice location
110 E E St
MC Cook, NE 69001-2049
Mailing address
807 Norris Ave
MC Cook, NE 69001-3144
Phone (308) 340-1165
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 54739511 | NE | MD | Day Training/Habilitation Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1735257600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1735257600000",
"number": "1730997396",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "807 NORRIS AVE",
"city": "MC COOK",
"state": "NE",
"postal_code": "690013144",
"telephone_number": "308-340-1165"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 E E ST",
"city": "MC COOK",
"state": "NE",
"postal_code": "690012049",
"telephone_number": "308-340-1165"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANDALL",
"first_name": "STACIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-12-27",
"last_updated": "2024-12-27",
"certification_date": "2024-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "373H00000X",
"taxonomy_group": "",
"desc": "Day Training/Habilitation Specialist",
"state": "NE",
"license": "54739511",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in MC Cook, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.