Provider Demographics
NPI:1225275118
Name:COSNER, ANGELA (RN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:COSNER
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:P O BOX 109
Mailing Address - Street 2:
Mailing Address - City:MT STROM
Mailing Address - State:WV
Mailing Address - Zip Code:26739
Mailing Address - Country:US
Mailing Address - Phone:304-693-7353
Mailing Address - Fax:
Practice Address - Street 1:204 JEFFERSON AVENUE
Practice Address - Street 2:GRANT COUNTY BOARD OF EDUCATION
Practice Address - City:PETERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26847
Practice Address - Country:US
Practice Address - Phone:304-257-1011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV40354163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse