MEDICARE: KOSISO L BERNARDS-OBI FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	26NJ00950900	NJ

General Provider Information

NPI Number	:	1861049140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KOSISO L BERNARDS-OBI FNP

Provider Business Mailing Address
First Line	:	1945 CORLIES AVE
Second Line	:
City	:	NEPTUNE
State	:	NJ
Zip	:	07753-5197
Country	:	US
Telephone Number	:	908-415-1100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1945 CORLIES AVE
Second Line	:
City	:	NEPTUNE
State	:	NJ
Zip	:	07753-5197
Country	:	US
Telephone Number	:	908-415-1100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2019
Last Update Date	:	10/14/2024

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