Provider Demographics
NPI:1275027823
Name:HOTOVY, AMANDA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:HOTOVY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16910 FRANCES ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2398
Mailing Address - Country:US
Mailing Address - Phone:402-505-8777
Mailing Address - Fax:402-933-7767
Practice Address - Street 1:16910 FRANCES ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2398
Practice Address - Country:US
Practice Address - Phone:402-505-8777
Practice Address - Fax:402-933-7767
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2251363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant