Healthcare Provider Details

I. General information

NPI: 1659805109
Provider Name (Legal Business Name): AMY PANDORF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2231 INDEPENDENCE DR
LINCOLN NE
68521-1121
US

IV. Provider business mailing address

2231 INDEPENDENCE DR
LINCOLN NE
68521-1121
US

V. Phone/Fax

Practice location:
  • Phone: 308-870-2018
  • Fax:
Mailing address:
  • Phone: 308-870-2018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMY PANDORF
Title or Position: FNP
Credential: APRN
Phone: 308-870-2018