Provider Demographics
NPI:1275705352
Name:KOPETZKY, NICOLE ROBIN
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ROBIN
Last Name:KOPETZKY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:ROBIN
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18010 R PLZ STE 107
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-1923
Mailing Address - Country:US
Mailing Address - Phone:402-318-7863
Mailing Address - Fax:402-318-7885
Practice Address - Street 1:18010 R PLZ STE 107
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-1923
Practice Address - Country:US
Practice Address - Phone:402-318-7863
Practice Address - Fax:402-318-7885
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE035231H00000X
NE230231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist