Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 165 | NE |
N | 2080P0006X | Developmental - Behavioral Pediatrician | 165 | NE |
NPI | 1003981069 |
---|---|
Provider Name | Dr. Kenton R. Amstutz |
First Address | Omaha, NE 68131-2136 |
Second Address | Boys Town, NE 68010-7513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2006 |
Last Update Date | 14/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G20127 | (02) | NE |