Healthcare Provider Details

I. General information

NPI: 1629094453
Provider Name (Legal Business Name): AMANDA M THOM APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 S BURLINGTON AVE STE 108
HASTINGS NE
68901
US

IV. Provider business mailing address

208 S BURLINGTON AVE STE 108
HASTINGS NE
68901-5943
US

V. Phone/Fax

Practice location:
  • Phone: 402-463-6300
  • Fax: 402-834-0665
Mailing address:
  • Phone: 402-463-6300
  • Fax: 402-834-0665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number110737
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: