Provider Demographics
NPI:1568668259
Name:COSSE, NICOLE Y (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:Y
Last Name:COSSE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 W ESPLANADE AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065
Mailing Address - Country:US
Mailing Address - Phone:504-712-8005
Mailing Address - Fax:504-712-8030
Practice Address - Street 1:1900 W ESPLANADE AVE
Practice Address - Street 2:STE 102
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065
Practice Address - Country:US
Practice Address - Phone:504-712-8005
Practice Address - Fax:504-712-8030
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1128111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
5X391Medicare UPIN