Provider Demographics
NPI:1326320169
Name:KOSITSKY, ANN MARA (RN, NP)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:MARA
Last Name:KOSITSKY
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1633 OLD BAYSHORE HWY
Mailing Address - Street 2:SUITE 245
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-1588
Mailing Address - Country:US
Mailing Address - Phone:510-527-5091
Mailing Address - Fax:
Practice Address - Street 1:1633 OLD BAYSHORE HWY
Practice Address - Street 2:SUITE 245
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-1588
Practice Address - Country:US
Practice Address - Phone:650-357-8834
Practice Address - Fax:650-357-8811
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA02504282836363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics