Healthcare Provider Details

I. General information

NPI: 1891465753
Provider Name (Legal Business Name): ARLIE KOZIOL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 MAIN ST
MANCHESTER CT
06040-6064
US

IV. Provider business mailing address

132 CARRIAGE DR
MIDDLEBURY CT
06762-1928
US

V. Phone/Fax

Practice location:
  • Phone: 860-649-6166
  • Fax:
Mailing address:
  • Phone: 203-709-1603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number10013
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: