Provider Demographics
NPI:1851817449
Name:KOSBRUK, DEANNA LEIGH (CHA-1)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:LEIGH
Last Name:KOSBRUK
Suffix:
Gender:F
Credentials:CHA-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX H
Mailing Address - Street 2:
Mailing Address - City:COPPER CENTER
Mailing Address - State:AK
Mailing Address - Zip Code:99573-0508
Mailing Address - Country:US
Mailing Address - Phone:907-822-5241
Mailing Address - Fax:888-959-2389
Practice Address - Street 1:MILE 111.5
Practice Address - Street 2:
Practice Address - City:COPPER CENTER
Practice Address - State:AK
Practice Address - Zip Code:99573-0508
Practice Address - Country:US
Practice Address - Phone:907-822-5241
Practice Address - Fax:888-959-2389
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker