Provider Demographics
NPI:1255602108
Name:KOSKO, AINE MARIE (FNP-C)
Entity type:Individual
Prefix:
First Name:AINE
Middle Name:MARIE
Last Name:KOSKO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3113 NOTTINGHAM LN
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-1564
Mailing Address - Country:US
Mailing Address - Phone:209-678-7722
Mailing Address - Fax:
Practice Address - Street 1:1329 SPANOS CT STE C3
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2806
Practice Address - Country:US
Practice Address - Phone:209-530-3774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA661809163W00000X
CA21495363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse