Provider Demographics
NPI:1104259589
Name:BOGARD, AMANDA KAY (ARNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAY
Last Name:BOGARD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:KAY
Other - Last Name:STRUBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9609 N 29TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68112-1523
Mailing Address - Country:US
Mailing Address - Phone:402-690-6974
Mailing Address - Fax:
Practice Address - Street 1:631 N 8TH ST
Practice Address - Street 2:
Practice Address - City:MISSOURI VALLEY
Practice Address - State:IA
Practice Address - Zip Code:51555
Practice Address - Country:US
Practice Address - Phone:712-642-2784
Practice Address - Fax:712-642-9259
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111914363L00000X, 363LF0000X
IAA134390363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner