Provider Demographics
NPI:1851811566
Name:SOULLIERE, AMANDA ELIZABETH (APRN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ELIZABETH
Last Name:SOULLIERE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:5112 RAVEN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68152-1745
Mailing Address - Country:US
Mailing Address - Phone:402-309-9946
Mailing Address - Fax:402-932-8863
Practice Address - Street 1:741 PINNACLE DR
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-6269
Practice Address - Country:US
Practice Address - Phone:402-932-8384
Practice Address - Fax:402-932-8863
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-23
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NEAPRN112215363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily