Healthcare Provider Details

I. General information

NPI: 1508431321
Provider Name (Legal Business Name): JERUD ROBERT COZINE NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

788 8TH AVE SE STE 300
CEDAR RAPIDS IA
52401-2106
US

IV. Provider business mailing address

788 8TH AVE SE STE 300
CEDAR RAPIDS IA
52401-2106
US

V. Phone/Fax

Practice location:
  • Phone: 319-861-7200
  • Fax: 319-861-7201
Mailing address:
  • Phone: 319-861-7200
  • Fax: 319-861-7201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA162492
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: