Healthcare Provider Details

I. General information

NPI: 1710667803
Provider Name (Legal Business Name): AMANDA LEA RAUH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 07/24/2023
Certification Date: 07/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11820 STANDING STONE DR
GRETNA NE
68028-7979
US

IV. Provider business mailing address

11820 STANDING STONE DR
GRETNA NE
68028-7979
US

V. Phone/Fax

Practice location:
  • Phone: 402-332-3903
  • Fax:
Mailing address:
  • Phone: 402-332-3903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number114898
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: