Provider Demographics
NPI:1437314796
Name:BECKENHAUER, AMBER LYNN (DO)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNN
Last Name:BECKENHAUER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:LYNN
Other - Last Name:STURZENEGGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:407 S 19TH ST
Mailing Address - Street 2:
Mailing Address - City:BLAIR
Mailing Address - State:NE
Mailing Address - Zip Code:68008-1907
Mailing Address - Country:US
Mailing Address - Phone:402-533-2223
Mailing Address - Fax:531-301-6272
Practice Address - Street 1:407 S 19TH ST
Practice Address - Street 2:
Practice Address - City:BLAIR
Practice Address - State:NE
Practice Address - Zip Code:68008-1907
Practice Address - Country:US
Practice Address - Phone:402-552-3222
Practice Address - Fax:402-552-2172
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE686207Q00000X
NETEP5892207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026889300Medicaid
NE47055301100Medicaid