Provider Demographics
NPI:1235126178
Name:COSMAS, MARIJO (MS, RN, AOCN, CRNP)
Entity Type:Individual
Prefix:
First Name:MARIJO
Middle Name:
Last Name:COSMAS
Suffix:
Gender:F
Credentials:MS, RN, AOCN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 STEEPLE CHASE DR
Mailing Address - Street 2:SUITE 404
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-4049
Mailing Address - Country:US
Mailing Address - Phone:410-535-2811
Mailing Address - Fax:410-535-1865
Practice Address - Street 1:301 STEEPLE CHASE DR
Practice Address - Street 2:SUITE 404
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4049
Practice Address - Country:US
Practice Address - Phone:410-535-2811
Practice Address - Fax:410-535-1865
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR059234363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD345PMedicare PIN
P91420Medicare UPIN