Provider Demographics
NPI:1134282775
Name:KOZAR, DOROTHY JANE (ACNP)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:JANE
Last Name:KOZAR
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:764 INVERNESS DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-6075
Mailing Address - Country:US
Mailing Address - Phone:336-414-3337
Mailing Address - Fax:336-245-8366
Practice Address - Street 1:764 INVERNESS DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-6075
Practice Address - Country:US
Practice Address - Phone:336-414-3337
Practice Address - Fax:336-245-8366
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC005002413363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care