Healthcare Provider Details

I. General information

NPI: 1154999233
Provider Name (Legal Business Name): AMANDA MILLER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA BOOKER

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/15/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N 102ND ST STE 300
OMAHA NE
68114-2122
US

IV. Provider business mailing address

1010 N 102ND ST STE 300
OMAHA NE
68114-2122
US

V. Phone/Fax

Practice location:
  • Phone: 619-821-3352
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number212884
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: