Provider Demographics
NPI:1275855967
Name:KOZAREC, MARY HELEN (MS, RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:HELEN
Last Name:KOZAREC
Suffix:
Gender:F
Credentials:MS, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 N CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45327-1105
Mailing Address - Country:US
Mailing Address - Phone:937-855-2308
Mailing Address - Fax:
Practice Address - Street 1:403 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:OH
Practice Address - Zip Code:45327-1105
Practice Address - Country:US
Practice Address - Phone:937-855-2308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-235567163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse