Healthcare Provider Details

I. General information

NPI: 1811809387
Provider Name (Legal Business Name): AMANDA JEAN NOLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 W Q ST APT 8
LINCOLN NE
68528-1757
US

IV. Provider business mailing address

515 W SAUNDERS AVE APT 12
LINCOLN NE
68521-3530
US

V. Phone/Fax

Practice location:
  • Phone: 402-314-3829
  • Fax:
Mailing address:
  • Phone: 402-314-3829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: