Provider Demographics
NPI:1457787566
Name:KASANZA, COSETTE CHANTAL (NP)
Entity Type:Individual
Prefix:
First Name:COSETTE
Middle Name:CHANTAL
Last Name:KASANZA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CHANTAL
Other - Middle Name:
Other - Last Name:KILABI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:2625 E DIVISADERO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1431
Mailing Address - Country:US
Mailing Address - Phone:559-443-2682
Mailing Address - Fax:559-443-2681
Practice Address - Street 1:290 N WAYTE LN
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-2124
Practice Address - Country:US
Practice Address - Phone:559-459-5721
Practice Address - Fax:559-459-4922
Is Sole Proprietor?:No
Enumeration Date:2013-09-20
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN721705163W00000X
CANP23434363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse