Provider Demographics
NPI:1659851178
Name:KOCISZEWSKI, CHRISTINE (APRN)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:KOCISZEWSKI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 PLEASANT STREET
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301
Mailing Address - Country:US
Mailing Address - Phone:603-622-8665
Mailing Address - Fax:833-413-4978
Practice Address - Street 1:254 PLEASANT STREET
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301
Practice Address - Country:US
Practice Address - Phone:603-622-8665
Practice Address - Fax:833-413-4978
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH071078-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3116171Medicaid