Healthcare Provider Details

I. General information

NPI: 1659285831
Provider Name (Legal Business Name): AMANDA DETHLOFF BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21813 DAYLILY CIR
ELKHORN NE
68022-4301
US

IV. Provider business mailing address

14733 ELM ST
OMAHA NE
68144-3224
US

V. Phone/Fax

Practice location:
  • Phone: 402-981-2863
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: