Provider Demographics
NPI:1649573411
Name:MALINA, AMANDA R (APRN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:R
Last Name:MALINA
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 1:1760 COUNTY ROAD J
Mailing Address - Street 2:
Mailing Address - City:WAHOO
Mailing Address - State:NE
Mailing Address - Zip Code:68066-4152
Mailing Address - Country:US
Mailing Address - Phone:402-443-4191
Mailing Address - Fax:402-443-1402
Practice Address - Street 1:1760 COUNTY ROAD J
Practice Address - Street 2:
Practice Address - City:WAHOO
Practice Address - State:NE
Practice Address - Zip Code:68066-4152
Practice Address - Country:US
Practice Address - Phone:402-443-4191
Practice Address - Fax:402-443-1402
Is Sole Proprietor?:No
Enumeration Date:2010-12-16
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111179363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily