Healthcare Provider Details

I. General information

NPI: 1619368024
Provider Name (Legal Business Name): CATHLEEN D KOSLOSKY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2015
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 CENTRE ST STE 200
BATH ME
04530
US

IV. Provider business mailing address

108 CENTRE ST STE 200
BATH ME
04530-2550
US

V. Phone/Fax

Practice location:
  • Phone: 207-386-1800
  • Fax: 207-386-1801
Mailing address:
  • Phone: 207-386-1800
  • Fax: 207-386-1801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP151001
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: