Healthcare Provider Details

I. General information

NPI: 1437854460
Provider Name (Legal Business Name): MACY LYNN KOBZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 LINE DRIVE CIR
LINCOLN NE
68508-4010
US

IV. Provider business mailing address

1310 43 1/2 RD
BELLWOOD NE
68624-2441
US

V. Phone/Fax

Practice location:
  • Phone: 402-472-4224
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: