Healthcare Provider Details

I. General information

NPI: 1124948963
Provider Name (Legal Business Name): MS. AMY LYNN JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY LYNN HOEFER RN

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 N 72ND ST
OMAHA NE
68122-1709
US

IV. Provider business mailing address

4919 S 79TH ST
RALSTON NE
68127-2703
US

V. Phone/Fax

Practice location:
  • Phone: 402-917-0890
  • Fax:
Mailing address:
  • Phone: 402-917-0890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number87416
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: