Provider Demographics
NPI:1447785233
Name:COSSAIRT, CHRISTINA MICHELLE
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MICHELLE
Last Name:COSSAIRT
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:PO BOX 1025
Mailing Address - Street 2:
Mailing Address - City:KENO
Mailing Address - State:OR
Mailing Address - Zip Code:97627-1025
Mailing Address - Country:US
Mailing Address - Phone:541-891-0312
Mailing Address - Fax:541-850-2512
Practice Address - Street 1:11489 RED WING LOOP
Practice Address - Street 2:
Practice Address - City:KENO
Practice Address - State:OR
Practice Address - Zip Code:97627-3093
Practice Address - Country:US
Practice Address - Phone:541-891-0312
Practice Address - Fax:541-850-2512
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-29
Last Update Date:2017-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula