Provider Demographics
NPI:1891083028
Name:AMICK, AMBER RENE (ARPN-NP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:RENE
Last Name:AMICK
Suffix:
Gender:F
Credentials:ARPN-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 642117
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-8117
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:109 N 29TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-3251
Practice Address - Country:US
Practice Address - Phone:402-644-4411
Practice Address - Fax:402-644-4422
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111258363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner