Healthcare Provider Details

I. General information

NPI: 1457225575
Provider Name (Legal Business Name): AMYE DUSATKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 WOOLWORTH AVE
OMAHA NE
68105-1850
US

IV. Provider business mailing address

11727 N 173RD CIR
BENNINGTON NE
68007-5745
US

V. Phone/Fax

Practice location:
  • Phone: 402-995-3239
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number75831
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: