Provider Demographics
NPI:1790277788
Name:KOZLOSKI, SANDRA LYNN
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:KOZLOSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 TRIEBLE DR STE 3
Mailing Address - Street 2:
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657-7055
Mailing Address - Country:US
Mailing Address - Phone:570-996-2700
Mailing Address - Fax:570-996-2735
Practice Address - Street 1:10 TRIEBLE DR STE 3
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-7055
Practice Address - Country:US
Practice Address - Phone:570-996-2700
Practice Address - Fax:570-996-2735
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN264592L163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory