Healthcare Provider Details

I. General information

NPI: 1467558833
Provider Name (Legal Business Name): AMANDA LEE GODDARD RN, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA LEE THOMAS RN, APRN

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5625 S 62ND ST STE 100
LINCOLN NE
68516-3558
US

IV. Provider business mailing address

5625 S 62ND ST STE 100
LINCOLN NE
68516-3558
US

V. Phone/Fax

Practice location:
  • Phone: 402-489-3834
  • Fax: 402-489-5049
Mailing address:
  • Phone: 402-489-3834
  • Fax: 24-895-0494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number110662
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: