Provider Demographics
NPI:1932197001
Name:KOZIOL, LYNN S (CRNA)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:S
Last Name:KOZIOL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4528 EVERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-5120
Mailing Address - Country:US
Mailing Address - Phone:713-667-7445
Mailing Address - Fax:
Practice Address - Street 1:4528 EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-5120
Practice Address - Country:US
Practice Address - Phone:713-667-7455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX042716367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX002219601Medicaid
TX89839COtherBLUE CROSS BLUE SHIELD
TX89839COtherBLUE CROSS BLUE SHIELD