1689031593 NPI number — MRS. EMMYLOU AMANDA FLANAGAN OTD

Table of content: MRS. EMMYLOU AMANDA FLANAGAN OTD (NPI 1689031593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689031593 NPI number — MRS. EMMYLOU AMANDA FLANAGAN OTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLANAGAN
Provider First Name:
EMMYLOU
Provider Middle Name:
AMANDA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTD
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:
1689031593
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16913 OAKMONT DR
Provider Second Line Business Mailing Address:
APT 11
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68136-4117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-216-1352
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10000 W 75TH ST
Provider Second Line Business Practice Location Address:
STE.250
Provider Business Practice Location Address City Name:
MERRIAM
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66204-2209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-913-1910
Provider Business Practice Location Address Fax Number:
877-913-1174
Provider Enumeration Date:
01/22/2016

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: 225X00000X , with the licence number:  901114 , 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)





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