MEDICARE: MR. NICKOLAS ALAN BOCKOVEN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	2989	NE

General Provider Information

NPI Number	:	1912627555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NICKOLAS ALAN BOCKOVEN PA-C

Provider Business Mailing Address
First Line	:	9850 NICHOLAS ST STE 250
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68114-2191
Country	:	US
Telephone Number	:	402-399-9990
Fax Number	:	402-399-9851

Provider Business Practice Location Address
First Line	:	5816 LAFAYETTE AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68132-1337
Country	:	US
Telephone Number	:	402-641-3135
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2022
Last Update Date	:	05/30/2023

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Directions to “ MR. NICKOLAS ALAN BOCKOVEN PA-C” Practice Location

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