Healthcare Provider Details

I. General information

NPI: 1184683039
Provider Name (Legal Business Name): SHARON S. KOZLOWSKI CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1780 HANSHAW RD
ITHACA NY
14850-9105
US

IV. Provider business mailing address

1 GUTHRIE SQ
SAYRE PA
18840-1625
US

V. Phone/Fax

Practice location:
  • Phone: 607-257-5858
  • Fax: 607-257-1718
Mailing address:
  • Phone: 570-888-5858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF331175-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: