1841755683 NPI number — MS. JESSICA S KOSKI BS, IBCLC, DOULA

Table of content: MS. JESSICA S KOSKI BS, IBCLC, DOULA (NPI 1841755683)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841755683 NPI number — MS. JESSICA S KOSKI BS, IBCLC, DOULA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOSKI
Provider First Name:
JESSICA
Provider Middle Name:
S
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
BS, IBCLC, DOULA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HULDERMAN
Provider Other First Name:
JESSICA
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841755683
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
128 NEEDLE POINTE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GUYTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31312-5151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-704-8105
Provider Business Mailing Address Fax Number:
912-200-7898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
813 E 66TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31405-4507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-704-8105
Provider Business Practice Location Address Fax Number:
912-200-5873
Provider Enumeration Date:
02/06/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 374J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174N00000X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)