Provider Demographics
NPI:1487635223
Name:COSSMAN, KATHARINE DF (RN)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:DF
Last Name:COSSMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KATHARINE
Other - Middle Name:DF
Other - Last Name:JAEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4329 E ARROWHEAD LN
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-9631
Mailing Address - Country:US
Mailing Address - Phone:608-751-0556
Mailing Address - Fax:
Practice Address - Street 1:4329 E ARROWHEAD LN
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-9631
Practice Address - Country:US
Practice Address - Phone:608-751-0556
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI75083-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39961000Medicaid