Provider Demographics
NPI:1669537056
Name:KOCOVSKY, DIANE LYNN (APRN)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:LYNN
Last Name:KOCOVSKY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:DIANE
Other - Middle Name:L
Other - Last Name:INGAMELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:555 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2136
Mailing Address - Country:US
Mailing Address - Phone:402-498-6509
Mailing Address - Fax:402-498-6357
Practice Address - Street 1:14080 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:BOYS TOWN
Practice Address - State:NE
Practice Address - Zip Code:68010-7513
Practice Address - Country:US
Practice Address - Phone:402-778-6900
Practice Address - Fax:402-778-6917
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110623363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100253323-00Medicaid
NE38843OtherBCBS