Provider Demographics
NPI:1689384752
Name:KOZOSKY, NICHOLE (LPN)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:KOZOSKY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4869 63RD ST
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-8057
Mailing Address - Country:US
Mailing Address - Phone:515-577-8024
Mailing Address - Fax:515-265-0845
Practice Address - Street 1:1223 CENTER ST STE 22
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1016
Practice Address - Country:US
Practice Address - Phone:515-218-6125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAP37231164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse