Healthcare Provider Details

I. General information

NPI: 1134184393
Provider Name (Legal Business Name): ELENA H COSIO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040A FITZSIMMON AVE
TACOMA WA
98431-0001
US

IV. Provider business mailing address

7114 57TH STREET CT W
UNIVERSITY PLACE WA
98467-2167
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-2053
  • Fax: 253-968-3521
Mailing address:
  • Phone: 253-968-2053
  • Fax: 253-968-3521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License NumberRN0126493
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: