Provider Demographics
NPI:1477263945
Name:COSENS, JAIME DENISE
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:DENISE
Last Name:COSENS
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 696
Mailing Address - Street 2:
Mailing Address - City:MENTMORE
Mailing Address - State:NM
Mailing Address - Zip Code:87319-0696
Mailing Address - Country:US
Mailing Address - Phone:505-870-7584
Mailing Address - Fax:
Practice Address - Street 1:CORNER ROUTE 7 AND ROUTE 12
Practice Address - Street 2:
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504-8731
Practice Address - Country:US
Practice Address - Phone:505-870-7584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-25
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM63154163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse