Provider Demographics
NPI:1457498065
Name:COSSMAN, CHANAH (CNM, NP)
Entity Type:Individual
Prefix:MS
First Name:CHANAH
Middle Name:
Last Name:COSSMAN
Suffix:
Gender:F
Credentials:CNM, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 F ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-3418
Mailing Address - Country:US
Mailing Address - Phone:559-266-0444
Mailing Address - Fax:559-266-7745
Practice Address - Street 1:829 F ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-3418
Practice Address - Country:US
Practice Address - Phone:559-266-0444
Practice Address - Fax:559-266-7745
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 5455363L00000X
CANMW 802367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Not Answered367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANMW008020Medicaid