Individual
AMANDA R. MILLEMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3830 N 167TH CT, OMAHA, NE 68116-8067
(402) 965-4000
(402) 965-4001
Mailing address
6910 PACIFIC ST, STE 100, OMAHA, NE 68106-1044
(402) 504-3707
(402) 504-3714
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1493
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1493
NE LICENSE
NE
Enumeration date
02/08/2010
Last updated
02/01/2019
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