Provider Demographics
NPI:1225893720
Name:KOZYK, GANNA
Entity Type:Individual
Prefix:
First Name:GANNA
Middle Name:
Last Name:KOZYK
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 1:9912 CAMBERLY CT
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-6653
Mailing Address - Country:US
Mailing Address - Phone:916-582-8533
Mailing Address - Fax:
Practice Address - Street 1:9912 CAMBERLY CT
Practice Address - Street 2:
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-6653
Practice Address - Country:US
Practice Address - Phone:916-582-8533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program