Provider Demographics
NPI:1043497126
Name:KOZLESKI, KAREN ANN (MSN, FNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:KOZLESKI
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ANN
Other - Last Name:ROSASCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3524 HEATHROW WAY
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4004
Mailing Address - Country:US
Mailing Address - Phone:541-646-3505
Mailing Address - Fax:
Practice Address - Street 1:3524 HEATHROW WAY
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4004
Practice Address - Country:US
Practice Address - Phone:541-646-3505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200650056NP FNP-PP163WP2201X
OR200650056NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care