Healthcare Provider Details

I. General information

NPI: 1164802716
Provider Name (Legal Business Name): ELIZABETH ANNE KOSIN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 EAST PARK AVE.
STATE COLLEGE PA
16803-8308
US

IV. Provider business mailing address

3945 S. ATHERTON ST.
STATE COLLEGE PA
16801
US

V. Phone/Fax

Practice location:
  • Phone: 814-231-7000
  • Fax:
Mailing address:
  • Phone: 814-466-5090
  • Fax: 814-466-5095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN524301L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: