Healthcare Provider Details

I. General information

NPI: 1467401760
Provider Name (Legal Business Name): LISA M KOZIOL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17021 LAKESIDE HILLS PLZ SUITE 100
OMAHA NE
68130-2390
US

IV. Provider business mailing address

17021 LAKESIDE HILLS PLZ SUITE 100
OMAHA NE
68130-2390
US

V. Phone/Fax

Practice location:
  • Phone: 402-333-0300
  • Fax: 402-333-0302
Mailing address:
  • Phone: 402-333-0300
  • Fax: 402-333-0302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number110676
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: