Provider Demographics
NPI:1952859456
Name:COSSETTE, LAURA LEIGH (CRNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LEIGH
Last Name:COSSETTE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 J ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5521
Mailing Address - Country:US
Mailing Address - Phone:164-534-7689
Mailing Address - Fax:916-733-6977
Practice Address - Street 1:3810 J ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5521
Practice Address - Country:US
Practice Address - Phone:916-453-4768
Practice Address - Fax:916-733-6977
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95007630363LF0000X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL63-0825248OtherAMERICAN FAMILY CARE INC.