Provider Demographics
NPI:1932375086
Name:KOZAK, GRACE YOLANDA (LPN)
Entity Type:Individual
Prefix:MS
First Name:GRACE
Middle Name:YOLANDA
Last Name:KOZAK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10620 86TH ST
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-1308
Mailing Address - Country:US
Mailing Address - Phone:917-362-4574
Mailing Address - Fax:
Practice Address - Street 1:825 E GATE BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-2124
Practice Address - Country:US
Practice Address - Phone:516-222-0092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199314-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse