Provider Demographics
NPI:1386631026
Name:KOCIAN, LYNN M (PAC)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:KOCIAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11820 STANDING STONE DR
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:NE
Mailing Address - Zip Code:68028-7979
Mailing Address - Country:US
Mailing Address - Phone:402-332-3903
Mailing Address - Fax:402-391-3076
Practice Address - Street 1:11820 STANDING STONE DR
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028-7979
Practice Address - Country:US
Practice Address - Phone:402-332-3903
Practice Address - Fax:402-391-3076
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE780363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE235047OtherMIDLANDS CHOICE
NE47053695301Medicaid
NE47053695301Medicaid
NES66505Medicare UPIN