Healthcare Provider Details

I. General information

NPI: 1902127442
Provider Name (Legal Business Name): AMANDA RAE KNAPP M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA RAE GOODENBERGER

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 S 70TH ST STE 110
LINCOLN NE
68516-4276
US

IV. Provider business mailing address

4501 S 70TH ST STE 110
LINCOLN NE
68516-4276
US

V. Phone/Fax

Practice location:
  • Phone: 402-489-3834
  • Fax:
Mailing address:
  • Phone: 402-489-3834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number04-36564
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2012008172
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number30277
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: