Provider Demographics
NPI:1164840286
Name:ENSZ, AMANDA LOUISE (MD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LOUISE
Last Name:ENSZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LOUISE
Other - Last Name:SWANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2115 14TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NE
Mailing Address - Zip Code:68305-1760
Mailing Address - Country:US
Mailing Address - Phone:402-274-4993
Mailing Address - Fax:402-274-4905
Practice Address - Street 1:2115 14TH ST STE 100
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NE
Practice Address - Zip Code:68305-1760
Practice Address - Country:US
Practice Address - Phone:402-274-4993
Practice Address - Fax:402-274-4905
Is Sole Proprietor?:No
Enumeration Date:2014-04-04
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI65081207R00000X
390200000X
NE31864207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program