Provider Demographics
NPI:1043010903
Name:RAY, SALLY
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:RAY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9744 MOCKINGBIRD DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-2013
Mailing Address - Country:US
Mailing Address - Phone:402-800-3787
Mailing Address - Fax:
Practice Address - Street 1:12662 IOWA CIR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68142-1695
Practice Address - Country:US
Practice Address - Phone:402-301-9045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion