Provider Demographics
NPI:1568434678
Name:COSMA, MONIQUE (NP)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:COSMA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6221 S CLAIBORNE AVE
Mailing Address - Street 2:STE 628
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70125-4142
Mailing Address - Country:US
Mailing Address - Phone:504-377-7707
Mailing Address - Fax:
Practice Address - Street 1:6221 S CLAIBORNE AVE
Practice Address - Street 2:STE 628
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125-4142
Practice Address - Country:US
Practice Address - Phone:504-377-7707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2020-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04293363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1176222Medicaid
LAQ01319Medicare UPIN
LA4C823Medicare ID - Type UnspecifiedMEDICARE NUMBER