1407843048 NPI number — AMY K ARNDT APRN

Table of content: AMY K ARNDT APRN (NPI 1407843048)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407843048 NPI number — AMY K ARNDT APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARNDT
Provider First Name:
AMY
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407843048
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
755 FALLBROOK BLVD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68521-9056
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-323-3360
Provider Business Mailing Address Fax Number:
402-438-2107

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
755 FALLBROOK BLVD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68521-9056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-323-3360
Provider Business Practice Location Address Fax Number:
402-438-2107
Provider Enumeration Date:
09/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP2300X , with the licence number:  110573 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 47-0824058-13 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110573 . This is a "NEBRASKA APRN ID#" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: P00440792 . This is a "MEDICARE TRAVELERS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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