Active NPI
Sara Theresa Dolezal, RN BSN IBCLC
- Lactation Consultant (Registered Nurse)
- Elkhorn, NE
National Provider Identifier
1740835669
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Lactation Consultant (Registered Nurse)
- License
- 87901
- Practice address
- 18018 Burke St
Elkhorn, NE 68022-4417 - Phone
- (402) 573-7337
- NPI assigned
- Aug 7, 2019
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Lactation Consultant (Registered Nurse) | 163WL0100X | 87901 | NE | Primary |
Addresses
Primary practice location
18018 Burke St
Elkhorn, NE 68022-4417
Mailing address
18018 Burke St
Elkhorn, NE 68022-4417
Phone (402) 573-7337
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 57901 | Medicaid | NE | |
| 57901 | Other | NE | PRIVATE |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | VPP | Other |
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
- Credentials
- Bachelor on Science - Nursing, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 87901 | NE | MD | Lactation Consultant (Registered Nurse) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1565136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565136000000",
"number": "1740835669",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18018 BURKE ST",
"city": "ELKHORN",
"state": "NE",
"postal_code": "680224417",
"telephone_number": "402-573-7337"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18018 BURKE ST",
"city": "ELKHORN",
"state": "NE",
"postal_code": "680224417",
"telephone_number": "402-573-7337"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOLEZAL",
"first_name": "SARA",
"middle_name": "THERESA",
"credential": "RN BSN IBCLC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-08-07",
"last_updated": "2019-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "163WL0100X",
"taxonomy_group": "",
"desc": "Registered Nurse, Lactation Consultant",
"state": "NE",
"license": "87901",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "57901",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRIVATE",
"identifier": "57901",
"state": "NE"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "VPP",
"affiliation": "N",
"endpointDescription": "18018 Burke Street Elkhorn NE 68022",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "18018 Burke Street",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "request",
"address_1": "18018 Burke St",
"city": "Elkhorn",
"state": "NE",
"country_code": "US",
"postal_code": "680224417",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Elkhorn, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.