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General NPI Number Information
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NPI Number | 1073162178
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Entity Type | Individual
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Provider Name | AMANDA GAIL IMPELLUSO ARNP
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Gender | Female
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Dates
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Enumeration Date | 09/10/2019
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 3802 RAYNOR PKWY STE 202
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City | BELLEVUE
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State | NE
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Zip | 68123-2528
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Country | US
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Telephone | 531-366-1204
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Fax |
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Provider Business Mailing Address
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Address Line | 3802 RAYNOR PKWY STE 202
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City | BELLEVUE
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State | NE
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Zip | 68123-2528
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Country | US
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Telephone | 531-366-1204
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 112819
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A128130
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License Number State | IA
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