Provider Demographics
NPI:1992216378
Name:KOHLES, MAGGIE MARIE (RN)
Entity Type:Individual
Prefix:MISS
First Name:MAGGIE
Middle Name:MARIE
Last Name:KOHLES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:MARIE
Other - Last Name:GALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:110 S VISITING EAGLE ST
Mailing Address - Street 2:
Mailing Address - City:NIOBRARA
Mailing Address - State:NE
Mailing Address - Zip Code:68760-7201
Mailing Address - Country:US
Mailing Address - Phone:402-857-2300
Mailing Address - Fax:402-857-2594
Practice Address - Street 1:110 S VISITING EAGLE ST
Practice Address - Street 2:
Practice Address - City:NIOBRARA
Practice Address - State:NE
Practice Address - Zip Code:68760-7201
Practice Address - Country:US
Practice Address - Phone:402-857-2300
Practice Address - Fax:402-857-2594
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR043182163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse