Healthcare Provider Details

I. General information

NPI: 1538175948
Provider Name (Legal Business Name): VIRGINIA NMN COZAD ARNP CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BOX 400 SOLDIER CREEK ROAD
ROSEBUD SD
57570
US

IV. Provider business mailing address

715 NORTH MAIN ST
VALENTINE NE
69201
US

V. Phone/Fax

Practice location:
  • Phone: 605-747-2231
  • Fax: 605-747-2216
Mailing address:
  • Phone: 402-376-1362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number110254
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: