Healthcare Provider Details

I. General information

NPI: 1669537056
Provider Name (Legal Business Name): DIANE LYNN KOCOVSKY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANE L INGAMELLS APRN

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 02/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14080 HOSPITAL RD
BOYS TOWN NE
68010-7513
US

IV. Provider business mailing address

555 N 30TH ST
OMAHA NE
68131-2136
US

V. Phone/Fax

Practice location:
  • Phone: 402-778-6900
  • Fax: 402-778-6917
Mailing address:
  • Phone: 402-498-6509
  • Fax: 402-498-6357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number110623
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: