Provider Demographics
NPI:1023815784
Name:KRUG, AMANDA MONIQUE
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MONIQUE
Last Name:KRUG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MONIQUE
Other - Last Name:NOPERI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3405 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501
Mailing Address - Country:US
Mailing Address - Phone:916-840-4894
Mailing Address - Fax:
Practice Address - Street 1:1820 HILLCREST DRIVE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005
Practice Address - Country:US
Practice Address - Phone:402-682-6599
Practice Address - Fax:402-682-6563
Is Sole Proprietor?:No
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant