1942554787 NPI number — KRISTEN SUSANNAH KOZAK CRNP

Table of content: KRISTEN SUSANNAH KOZAK CRNP (NPI 1942554787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942554787 NPI number — KRISTEN SUSANNAH KOZAK CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOZAK
Provider First Name:
KRISTEN
Provider Middle Name:
SUSANNAH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HILEMAN
Provider Other First Name:
KRISTEN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942554787
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3056 MENOHER BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOHNSTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15905-5603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-483-2146
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SOMERSET HOSPITAL
Provider Second Line Business Practice Location Address:
225 SOUTH CENTER AVE
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-443-5800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/01/2012

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: 363LF0000X , with the licence number:  SP012885 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1942554787 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".