Healthcare Provider Details

I. General information

NPI: 1396354791
Provider Name (Legal Business Name): JENNIFER KOBIELA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2020
Last Update Date: 07/31/2020
Certification Date: 07/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4509 N 205TH AVE
ELKHORN NE
68022-4690
US

IV. Provider business mailing address

4509 N 205TH AVE
ELKHORN NE
68022-4690
US

V. Phone/Fax

Practice location:
  • Phone: 402-740-6963
  • Fax:
Mailing address:
  • Phone: 402-740-6963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number62179
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: