Provider Demographics
NPI:1093955197
Name:BORGMANN, AMY L (PA-C)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:L
Last Name:BORGMANN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:WINTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 255
Mailing Address - Street 2:
Mailing Address - City:CREIGHTON
Mailing Address - State:NE
Mailing Address - Zip Code:68729-0255
Mailing Address - Country:US
Mailing Address - Phone:402-358-5700
Mailing Address - Fax:402-358-5797
Practice Address - Street 1:1503 MAIN ST
Practice Address - Street 2:
Practice Address - City:CREIGHTON
Practice Address - State:NE
Practice Address - Zip Code:68729-3007
Practice Address - Country:US
Practice Address - Phone:402-358-5700
Practice Address - Fax:402-358-5797
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1428363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant