Provider Demographics
NPI:1023213162
Name:TEGELS, AMY J (APRN)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:J
Last Name:TEGELS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 S 23RD ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSMOUTH
Mailing Address - State:NE
Mailing Address - Zip Code:68048-2903
Mailing Address - Country:US
Mailing Address - Phone:402-298-4347
Mailing Address - Fax:402-298-4349
Practice Address - Street 1:211 S 23RD ST
Practice Address - Street 2:
Practice Address - City:PLATTSMOUTH
Practice Address - State:NE
Practice Address - Zip Code:68048-2903
Practice Address - Country:US
Practice Address - Phone:402-298-4347
Practice Address - Fax:402-298-4349
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-117058363LF0000X
NE110895363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE24388OtherBCBS
NEP00826854Medicare PIN
NENA1466003Medicare PIN
NE99827002Medicare PIN