Provider Demographics
NPI:1306654413
Name:PANICUCCI, AMANDA LEE (CNA, CMA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:PANICUCCI
Suffix:
Gender:F
Credentials:CNA, CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5618 N 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68110-1134
Mailing Address - Country:US
Mailing Address - Phone:531-299-2062
Mailing Address - Fax:531-299-2078
Practice Address - Street 1:5618 N 14TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68110-1134
Practice Address - Country:US
Practice Address - Phone:531-299-2062
Practice Address - Fax:531-299-2078
Is Sole Proprietor?:No
Enumeration Date:2024-12-20
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant