Provider Demographics
NPI:1770874570
Name:THEESEN, AMY ELIZABETH (APRN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:THEESEN
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 1:800 N ALPHA ST
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4320
Mailing Address - Country:US
Mailing Address - Phone:308-382-2010
Mailing Address - Fax:308-382-9549
Practice Address - Street 1:800 N ALPHA ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4320
Practice Address - Country:US
Practice Address - Phone:308-382-2010
Practice Address - Fax:308-382-9549
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111250363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily