Healthcare Provider Details

I. General information

NPI: 1366241846
Provider Name (Legal Business Name): AMANDA NICOLE RABER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 22ND AVE
KEARNEY NE
68845-2206
US

IV. Provider business mailing address

816 22ND AVE STE 100
KEARNEY NE
68845-2226
US

V. Phone/Fax

Practice location:
  • Phone: 308-455-3600
  • Fax:
Mailing address:
  • Phone: 308-865-2263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number101952
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number84565
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: