Healthcare Provider Details

I. General information

NPI: 1982300356
Provider Name (Legal Business Name): SCOTT A. KOCHANEK RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL CENTER BLVD
WINSTON SALEM NC
27157-0001
US

IV. Provider business mailing address

239 ACORN LN
MOCKSVILLE NC
27028-7865
US

V. Phone/Fax

Practice location:
  • Phone: 336-713-6000
  • Fax:
Mailing address:
  • Phone: 336-655-8767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number189520
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: