Healthcare Provider Details

I. General information

NPI: 1164567749
Provider Name (Legal Business Name): RACHEL LYNNE KOZOL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 WOOLWORTH AVE
OMAHA NE
68105
US

IV. Provider business mailing address

4102 WOOLWORTH AVE
OMAHA NE
68105
US

V. Phone/Fax

Practice location:
  • Phone: 402-444-7931
  • Fax: 402-444-6338
Mailing address:
  • Phone: 402-444-7931
  • Fax: 402-444-6338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number110697
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: