Provider Demographics
NPI:1295848646
Name:KOSIK, JOANN (MHA, PA-C)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:KOSIK
Suffix:
Gender:F
Credentials:MHA, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 MCALPINE ST
Mailing Address - Street 2:
Mailing Address - City:AVOCA
Mailing Address - State:PA
Mailing Address - Zip Code:18641-1140
Mailing Address - Country:US
Mailing Address - Phone:570-457-9299
Mailing Address - Fax:570-457-5014
Practice Address - Street 1:824 MCALPINE ST
Practice Address - Street 2:
Practice Address - City:AVOCA
Practice Address - State:PA
Practice Address - Zip Code:18641-1140
Practice Address - Country:US
Practice Address - Phone:570-457-9299
Practice Address - Fax:570-457-5014
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA000366L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical