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General NPI Number Information
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NPI Number | 1467910034
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Entity Type | Individual
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Provider Name | AMANDA DELISE HUERTA
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Gender | Female
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Dates
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Enumeration Date | 03/03/2019
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Last Update Date | 09/28/2023
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Provider Practice Location Address
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Address Line | 3721 W 13TH ST STE A
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City | GRAND ISLAND
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State | NE
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Zip | 68803-3205
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Country | US
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Telephone | 308-210-2205
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Fax | 308-210-2206
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Provider Business Mailing Address
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Address Line | 1907 E AVE
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City | KEARNEY
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State | NE
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Zip | 68847-6236
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Country | US
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Telephone | 816-266-0060
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 114057
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License Number State | NE
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