Provider Demographics
NPI:1831300144
Name:KOSLAWY, MARIA A (APRN)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:A
Last Name:KOSLAWY
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 1:8 VISTA DR
Mailing Address - Street 2:EASTPORT NORTH BUSINESS PARK
Mailing Address - City:OLD LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06371-1587
Mailing Address - Country:US
Mailing Address - Phone:860-434-8847
Mailing Address - Fax:860-434-0428
Practice Address - Street 1:8 VISTA DR
Practice Address - Street 2:EASTPORT NORTH BUSINESS PARK
Practice Address - City:OLD LYME
Practice Address - State:CT
Practice Address - Zip Code:06371-1587
Practice Address - Country:US
Practice Address - Phone:860-434-8847
Practice Address - Fax:860-434-0428
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002267363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTQ26516Medicare UPIN