Provider Demographics
NPI:1851549950
Name:KOZAK, CHARLENE (RN)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:
Last Name:KOZAK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 FRANKLIN ST STE 400
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-2412
Mailing Address - Country:US
Mailing Address - Phone:716-856-2702
Mailing Address - Fax:716-856-8034
Practice Address - Street 1:170 FRANKLIN ST STE 400
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-2412
Practice Address - Country:US
Practice Address - Phone:716-856-2702
Practice Address - Fax:716-856-8034
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY502217251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health