Provider Demographics
NPI:1902836059
Name:COSBY, ELLEN (CRNA)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:COSBY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 LIMESTONE RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5505
Mailing Address - Country:US
Mailing Address - Phone:302-995-1860
Mailing Address - Fax:302-995-5421
Practice Address - Street 1:2005 LIMESTONE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5505
Practice Address - Country:US
Practice Address - Phone:302-995-1860
Practice Address - Fax:302-995-5421
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDL6--0A00068367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEP00040552OtherRAILROAD MEDICARE
DE010946D50Medicare PIN