Provider Demographics
NPI:1275293540
Name:KOVALEVA, MARIYA A (RN, PHD, AGPCNP-BC)
Entity Type:Individual
Prefix:DR
First Name:MARIYA
Middle Name:A
Last Name:KOVALEVA
Suffix:
Gender:F
Credentials:RN, PHD, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985330 NEBRASKA MEDICAL CTR OFC 50113
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-5330
Mailing Address - Country:US
Mailing Address - Phone:402-559-6548
Mailing Address - Fax:
Practice Address - Street 1:730 S 38TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-1107
Practice Address - Country:US
Practice Address - Phone:402-559-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE92715163W00000X
NE113558363LP2300X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care