Provider Demographics
NPI:1629094453
Name:THOM, AMANDA M (APRN)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:M
Last Name:THOM
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 1:208 S BURLINGTON AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-5943
Mailing Address - Country:US
Mailing Address - Phone:402-463-6300
Mailing Address - Fax:402-834-0665
Practice Address - Street 1:208 S BURLINGTON AVE STE 108
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901
Practice Address - Country:US
Practice Address - Phone:402-463-6300
Practice Address - Fax:402-834-0665
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110737363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE307062OtherCONVENTRY
NE37907OtherBLUE CROSS BLUE SHIELD
NE248640OtherMIDLANDS CHOICE
NE39385OtherBLUE CROSS BLUE SHIELD
NEQ59769Medicare UPIN
NE280944Medicare PIN
NE248640OtherMIDLANDS CHOICE