Provider Demographics
NPI:1568005015
Name:KUKOLY, BELINDA LEE (RN)
Entity type:Individual
Prefix:MRS
First Name:BELINDA
Middle Name:LEE
Last Name:KUKOLY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 N. 9TH STREET
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025
Mailing Address - Country:US
Mailing Address - Phone:402-727-3000
Mailing Address - Fax:402-727-3062
Practice Address - Street 1:515 S BROAD ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-5634
Practice Address - Country:US
Practice Address - Phone:402-727-3038
Practice Address - Fax:402-727-3049
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE35333163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool