Provider Demographics
NPI:1912155607
Name:CANINE, AMY NADINE (AUD)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:NADINE
Last Name:CANINE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8005 FARNAM DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3426
Mailing Address - Country:US
Mailing Address - Phone:402-933-3277
Mailing Address - Fax:402-933-2216
Practice Address - Street 1:8005 FARNAM DR
Practice Address - Street 2:SUITE 206
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3426
Practice Address - Country:US
Practice Address - Phone:402-933-3277
Practice Address - Fax:402-933-2216
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE008231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAS38525Medicare UPIN