Healthcare Provider Details

I. General information

NPI: 1003276676
Provider Name (Legal Business Name): ERIN KOSAK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2016
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 WAPPOO CREEK DR
CHARLESTON SC
29412-2135
US

IV. Provider business mailing address

109 WAPPOO CREEK DR
CHARLESTON SC
29412-2135
US

V. Phone/Fax

Practice location:
  • Phone: 843-796-7171
  • Fax: 843-795-7171
Mailing address:
  • Phone: 843-796-7171
  • Fax: 843-795-7171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number19923
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: