MEDICARE: MRS. AMY J TEGELS APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	A-117058	IA
2	363LF0000X	Family Nurse Practitioner	110895	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	24388	OTHER	NE	BCBS

General Provider Information

NPI Number	:	1023213162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY J TEGELS APRN

Provider Business Mailing Address
First Line	:	211 S 23RD ST
Second Line	:
City	:	PLATTSMOUTH
State	:	NE
Zip	:	68048-2903
Country	:	US
Telephone Number	:	402-298-4347
Fax Number	:	402-298-4349

Provider Business Practice Location Address
First Line	:	211 S 23RD ST
Second Line	:
City	:	PLATTSMOUTH
State	:	NE
Zip	:	68048-2903
Country	:	US
Telephone Number	:	402-298-4347
Fax Number	:	402-298-4349

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	05/14/2015

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