Provider Demographics
NPI:1629379821
Name:LOSCO, MARYANN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:MARYANN
Middle Name:
Last Name:LOSCO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 BARD AVENUE MEDICAL CREDENTIALS OFFICE
Mailing Address - Street 2:RICHMOND UNIVERSITY MEDICAL CTR
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310
Mailing Address - Country:US
Mailing Address - Phone:718-818-2476
Mailing Address - Fax:718-818-2578
Practice Address - Street 1:355 BARD AVE
Practice Address - Street 2:RICHMOND UNIVERSITY MEDICAL CTR
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310
Practice Address - Country:US
Practice Address - Phone:718-818-2476
Practice Address - Fax:718-818-2578
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF420158-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner