Healthcare Provider Details

I. General information

NPI: 1235589714
Provider Name (Legal Business Name): COURTNEY KOSNIK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24411 CHERYL KELTON PL
NEWHALL CA
91321-2330
US

IV. Provider business mailing address

23823 VALENCIA BLVD STE 140
VALENCIA CA
91355-9516
US

V. Phone/Fax

Practice location:
  • Phone: 310-897-7014
  • Fax:
Mailing address:
  • Phone: 661-290-3337
  • Fax: 661-253-3756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95004280
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: