Provider Demographics
NPI:1750352480
Name:MAHAR, AMY S (PAC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:S
Last Name:MAHAR
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1916 AVENUE G
Mailing Address - Street 2:
Mailing Address - City:GOTHENBURG
Mailing Address - State:NE
Mailing Address - Zip Code:69138-1428
Mailing Address - Country:US
Mailing Address - Phone:308-529-2026
Mailing Address - Fax:308-534-4013
Practice Address - Street 1:611 W FRANCIS ST STE 200
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-0614
Practice Address - Country:US
Practice Address - Phone:308-568-3500
Practice Address - Fax:308-534-4013
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE1066363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE39188OtherBC/BS
278006Medicare ID - Type Unspecified
NE39188OtherBC/BS
281694Medicare PIN