Provider Demographics
NPI:1144647975
Name:LURA, AMANDA L (CNM)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:LURA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7205 W CENTER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2388
Mailing Address - Country:US
Mailing Address - Phone:402-397-6600
Mailing Address - Fax:402-397-8318
Practice Address - Street 1:515 N 162ND AVE STE 102
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-2540
Practice Address - Country:US
Practice Address - Phone:402-505-9493
Practice Address - Fax:402-504-3723
Is Sole Proprietor?:No
Enumeration Date:2014-03-18
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE120055367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE092208009Medicare PIN
NE10026480100Medicaid
IA1144647975Medicaid
NE099099208Medicare UPIN
NE47068731799Medicaid