Basic Information
| Provider Information | |||||||||
| NPI: | 1851811566 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOULLIERE | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5112 RAVEN OAKS DR | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681521745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023099946 | ||||||||
| FaxNumber: | 4029328863 | ||||||||
| Practice Location | |||||||||
| Address1: | 741 PINNACLE DR | ||||||||
| Address2: | |||||||||
| City: | PAPILLION | ||||||||
| State: | NE | ||||||||
| PostalCode: | 680466269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4029328384 | ||||||||
| FaxNumber: | 4029328863 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2017 | ||||||||
| LastUpdateDate: | 06/23/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN112215 | NE | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.