Healthcare Provider Details

I. General information

NPI: 1902281413
Provider Name (Legal Business Name): AMY MAYER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2015
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

989200 NEBRASKA MEDICAL CANTER
OMAHA NE
68198-3910
US

IV. Provider business mailing address

4707 N 158TH PLZ APT 24
OMAHA NE
68116-4007
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-2484
  • Fax:
Mailing address:
  • Phone: 402-651-8185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14934
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number14934
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: