Healthcare Provider Details

I. General information

NPI: 1609684703
Provider Name (Legal Business Name): OLHA EVGENEVNA KOTLIAROVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 SW 11TH ST
LINCOLN NE
68522-2619
US

IV. Provider business mailing address

1521 SW 11TH ST
LINCOLN NE
68522-2619
US

V. Phone/Fax

Practice location:
  • Phone: 402-570-6630
  • Fax:
Mailing address:
  • Phone: 402-570-6630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: