Provider Demographics
NPI:1134577497
Name:KOSBRUK, MARGRETTE
Entity type:Individual
Prefix:
First Name:MARGRETTE
Middle Name:
Last Name:KOSBRUK
Suffix:
Gender:F
Credentials:
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 48033
Mailing Address - Street 2:
Mailing Address - City:CHIGNIK LAKE
Mailing Address - State:AK
Mailing Address - Zip Code:99548-0033
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2236 ALDER LANE
Practice Address - Street 2:
Practice Address - City:CHIGNIK LAKE
Practice Address - State:AK
Practice Address - Zip Code:99548-0033
Practice Address - Country:US
Practice Address - Phone:907-845-2236
Practice Address - Fax:907-845-2223
Is Sole Proprietor?:No
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK14-1282III172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker