MEDICARE: LYNN S KOZIOL CRNA

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	367500000X	Certified Registered Nurse Anesthetist	042716	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	89839C	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1932197001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN S KOZIOL CRNA

Provider Business Mailing Address
First Line	:	4528 EVERGREEN ST
Second Line	:
City	:	BELLAIRE
State	:	TX
Zip	:	77401-5120
Country	:	US
Telephone Number	:	713-667-7445
Fax Number	:

Provider Business Practice Location Address
First Line	:	4528 EVERGREEN ST
Second Line	:
City	:	BELLAIRE
State	:	TX
Zip	:	77401-5120
Country	:	US
Telephone Number	:	713-667-7455
Fax Number	:

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	05/17/2010

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