Provider Demographics
NPI:1154318798
Name:KOSMACH, LYNNE M (NP, CDE)
Entity Type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:M
Last Name:KOSMACH
Suffix:
Gender:F
Credentials:NP, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55803-2547
Mailing Address - Country:US
Mailing Address - Phone:218-728-5375
Mailing Address - Fax:
Practice Address - Street 1:927 TRETTEL LN
Practice Address - Street 2:
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-1345
Practice Address - Country:US
Practice Address - Phone:218-879-1227
Practice Address - Fax:218-878-2136
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-1089282363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN911017800Medicaid
MN500000698Medicare ID - Type Unspecified
MNS707141Medicare UPIN