Healthcare Provider Details

I. General information

NPI: 1902836059
Provider Name (Legal Business Name): ELLEN COSBY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 LIMESTONE RD SUITE 5
WILMINGTON DE
19808-5505
US

IV. Provider business mailing address

2005 LIMESTONE RD SUITE 5
WILMINGTON DE
19808-5505
US

V. Phone/Fax

Practice location:
  • Phone: 302-995-1860
  • Fax: 302-995-5421
Mailing address:
  • Phone: 302-995-1860
  • Fax: 302-995-5421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberL6--0A00068
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: