Healthcare Provider Details

I. General information

NPI: 1467188441
Provider Name (Legal Business Name): KRISTINA ANN KOUBA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 VICKI LN
NORFOLK NE
68701-4558
US

IV. Provider business mailing address

84658 553RD AVE
NORFOLK NE
68701-1439
US

V. Phone/Fax

Practice location:
  • Phone: 402-379-0040
  • Fax: 402-379-0759
Mailing address:
  • Phone: 402-860-0951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number72348
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: