Healthcare Provider Details

I. General information

NPI: 1124917760
Provider Name (Legal Business Name): LISA ANN KOCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 JONES ST
WINSIDE NE
68790-5113
US

IV. Provider business mailing address

216 JONES ST
WINSIDE NE
68790-5113
US

V. Phone/Fax

Practice location:
  • Phone: 402-615-2613
  • Fax:
Mailing address:
  • Phone: 402-615-2613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: