Healthcare Provider Details

I. General information

NPI: 1043132756
Provider Name (Legal Business Name): AMANDA BAUMGARDNER ABOC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S DEWEY ST
NORTH PLATTE NE
69101-7650
US

IV. Provider business mailing address

1401 S DEWEY ST
NORTH PLATTE NE
69101-7650
US

V. Phone/Fax

Practice location:
  • Phone: 308-532-0220
  • Fax: 308-532-0500
Mailing address:
  • Phone: 308-532-0220
  • Fax: 308-532-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number264382
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: