Provider Demographics
NPI:1447124789
Name:OLIVE, SANDRA MAE
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:MAE
Last Name:OLIVE
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 1:4535 NORMAL BLVD STE 235
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-2891
Mailing Address - Country:US
Mailing Address - Phone:402-207-1050
Mailing Address - Fax:402-207-1050
Practice Address - Street 1:4535 NORMAL BLVD STE 235
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2891
Practice Address - Country:US
Practice Address - Phone:402-207-1050
Practice Address - Fax:402-207-1050
Is Sole Proprietor?:No
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE372500000X, 376J00000X, 3747P1801X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372500000XNursing Service Related ProvidersChore Provider
No376J00000XNursing Service Related ProvidersHomemaker
No372600000XNursing Service Related ProvidersAdult Companion