Provider Demographics
NPI:1053624767
Name:VAN DYKE, AMBER L (APRN)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:L
Last Name:VAN DYKE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 DIANE ST
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-8024
Mailing Address - Country:US
Mailing Address - Phone:402-321-0080
Mailing Address - Fax:
Practice Address - Street 1:987740 NEBRASKA MEDICAL CTR
Practice Address - Street 2:NEONATAL INTENSIVE CARE UNIT
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-7740
Practice Address - Country:US
Practice Address - Phone:402-559-4442
Practice Address - Fax:402-559-8685
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111152363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal