Healthcare Provider Details

I. General information

NPI: 1043497126
Provider Name (Legal Business Name): KAREN ANN KOZLESKI MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN ANN ROSASCO

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3524 HEATHROW WAY
MEDFORD OR
97504-4004
US

IV. Provider business mailing address

3524 HEATHROW WAY
MEDFORD OR
97504-4004
US

V. Phone/Fax

Practice location:
  • Phone: 541-646-3505
  • Fax:
Mailing address:
  • Phone: 541-646-3505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number200650056NP FNP-PP
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200650056NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: