Provider Demographics
NPI:1659720803
Name:KOZLOWSKI, CONSTANCE JEAN (CRNP)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:JEAN
Last Name:KOZLOWSKI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 DONATION RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16125-1789
Mailing Address - Country:US
Mailing Address - Phone:724-588-2500
Mailing Address - Fax:724-588-5024
Practice Address - Street 1:60 FREDONIA RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-7901
Practice Address - Country:US
Practice Address - Phone:724-588-1018
Practice Address - Fax:724-588-5036
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP005918B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily