Provider Demographics
NPI:1861645129
Name:KOSNIK, CALLAN L (PA)
Entity Type:Individual
Prefix:
First Name:CALLAN
Middle Name:L
Last Name:KOSNIK
Suffix:
Gender:F
Credentials:PA
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 646
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98041-0646
Mailing Address - Country:US
Mailing Address - Phone:425-485-3955
Mailing Address - Fax:425-485-1476
Practice Address - Street 1:10025 NE 186TH ST
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3839
Practice Address - Country:US
Practice Address - Phone:425-486-9131
Practice Address - Fax:425-486-9490
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60051187363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical