Individual
DIANE MCCOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1116 JEFFERSON ST, GOTHENBURG, NE 69138-1854
(308) 529-1368
Mailing address
1116 JEFFERSON ST, GOTHENBURG, NE 69138-1854
(308) 529-1368
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
18128
NE
372500000X
Chore Provider
18128
NE
Other
Enumeration date
10/15/2014
Last updated
10/15/2014
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