Provider Demographics
NPI:1669437679
Name:KOZLOWSKI, GAIL B (LPN, LMT)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:B
Last Name:KOZLOWSKI
Suffix:
Gender:F
Credentials:LPN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5 MORGAN HWY
Mailing Address - Street 2:SUITE #4
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-2641
Mailing Address - Country:US
Mailing Address - Phone:570-344-3788
Mailing Address - Fax:570-614-0212
Practice Address - Street 1:5 MORGAN HWY
Practice Address - Street 2:SUITE #4
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-2641
Practice Address - Country:US
Practice Address - Phone:570-344-3788
Practice Address - Fax:570-614-0212
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAPN258952L164W00000X
PAMSG000066225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No164W00000XNursing Service ProvidersLicensed Practical Nurse