Provider Demographics
NPI:1518761535
Name:KOSENCEVA, TATIANA
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:KOSENCEVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14624 PRATT CT APT 102
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-8202
Mailing Address - Country:US
Mailing Address - Phone:531-270-6173
Mailing Address - Fax:
Practice Address - Street 1:14624 PRATT CT APT 103
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-8202
Practice Address - Country:US
Practice Address - Phone:531-270-6173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant