=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457696486
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A & J INDUSTRIES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2012
-----------------------------------------------------
Last Update Date | 04/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2302 8TH AVE STE 4
-----------------------------------------------------
City | PLATTSMOUTH
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68048-2365
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-298-4347
-----------------------------------------------------
Fax | 402-298-4349
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2302 8TH AVE STE 4
-----------------------------------------------------
City | PLATTSMOUTH
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68048-2365
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-298-4347
-----------------------------------------------------
Fax | 402-298-4349
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. AMY J TEGELS
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 402-298-4347
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 110895
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------