Healthcare Provider Details

I. General information

NPI: 1609716661
Provider Name (Legal Business Name): AMANDA WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9314 BINNEY ST
OMAHA NE
68134-4614
US

IV. Provider business mailing address

17237 340TH ST
TREYNOR IA
51575-6099
US

V. Phone/Fax

Practice location:
  • Phone: 402-934-2224
  • Fax:
Mailing address:
  • Phone: 402-708-2170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number114292
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: