Healthcare Provider Details

I. General information

NPI: 1093924185
Provider Name (Legal Business Name): COZETTA M HOSSAIN RNC, IBCLC, RLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6110 E WILSHIRE DR
SCOTTSDALE AZ
85257-1960
US

IV. Provider business mailing address

6110 E WILSHIRE DR
SCOTTSDALE AZ
85257-1960
US

V. Phone/Fax

Practice location:
  • Phone: 480-664-9751
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN111288
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: