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General NPI Number Information
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NPI Number | 1487169116
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Entity Type | Individual
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Provider Name | KENDRA AMIDON LMT
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Gender | Female
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Dates
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Enumeration Date | 12/04/2017
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Last Update Date | 10/03/2019
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Provider Practice Location Address
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Address Line | 12040 MCDERMOTT PLZ STE 320
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City | LA VISTA
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State | NE
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Zip | 68128-2354
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Country | US
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Telephone | 402-871-8469
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Fax | 402-597-2869
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Provider Business Mailing Address
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Address Line | 8825 S 117TH ST
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City | LA VISTA
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State | NE
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Zip | 68128-5567
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Country | US
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Telephone | 402-871-8469
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Fax | 402-597-2869
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 3340
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License Number State | NE
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