Provider Demographics
NPI:1831823970
Name:LERDAHL, ARICA AMANDA ELIZABETH
Entity type:Individual
Prefix:MRS
First Name:ARICA
Middle Name:AMANDA ELIZABETH
Last Name:LERDAHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 N 52ND ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-5012
Mailing Address - Country:US
Mailing Address - Phone:402-214-5502
Mailing Address - Fax:
Practice Address - Street 1:1523 N 52ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-5012
Practice Address - Country:US
Practice Address - Phone:402-214-5502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical