Healthcare Provider Details

I. General information

NPI: 1952859456
Provider Name (Legal Business Name): LAURA LEIGH COSSETTE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 J ST
SACRAMENTO CA
95816-5521
US

IV. Provider business mailing address

3810 J ST
SACRAMENTO CA
95816-5521
US

V. Phone/Fax

Practice location:
  • Phone: 916-453-4768
  • Fax: 916-733-6977
Mailing address:
  • Phone: 164-534-7689
  • Fax: 916-733-6977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95007630
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: