Active NPI
Sandra N Sullivan
- Licensed Practical Nurse
- Omaha, NE
National Provider Identifier
1750235503
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 22219
- Practice address
- 4102 Woolworth Ave
Omaha, NE 68105-1851 - Phone
- (402) 999-8506
- Fax
- (612) 725-1311
- NPI assigned
- Feb 26, 2026
- 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 |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 22219 | NE | Primary |
Addresses
Primary practice location
4102 Woolworth Ave
Omaha, NE 68105-1851
Mailing address
11336 Raleigh Dr
Omaha, NE 68164-2257
Phone (402) 999-8506
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 |
|---|---|---|---|
| 22219 | NE | MD | Sports Medicine (Orthopaedic Surgery) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1772064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1772064000000",
"number": "1750235503",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11336 RALEIGH DR",
"city": "OMAHA",
"state": "NE",
"postal_code": "681642257",
"telephone_number": "402-999-8506"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4102 WOOLWORTH AVE",
"city": "OMAHA",
"state": "NE",
"postal_code": "681051851",
"telephone_number": "402-999-8506",
"fax_number": "612-725-1311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "SANDRA",
"middle_name": "N",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-02-26",
"last_updated": "2026-02-26",
"certification_date": "2026-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "NE",
"license": "22219",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.