Healthcare Provider Details

I. General information

NPI: 1740511732
Provider Name (Legal Business Name): NATHAN L. KOTERA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 03/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 COUNTY ROAD J
WAHOO NE
68066-4152
US

IV. Provider business mailing address

1760 COUNTY ROAD J
WAHOO NE
68066-4152
US

V. Phone/Fax

Practice location:
  • Phone: 402-443-4191
  • Fax: 402-443-1402
Mailing address:
  • Phone: 402-443-4191
  • Fax: 402-443-1402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1483
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: