Healthcare Provider Details

I. General information

NPI: 1588909196
Provider Name (Legal Business Name): DOROTHY KOZAKOWSKI DNP, APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2012
Last Update Date: 11/04/2023
Certification Date: 11/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6525 GREEN BAY RD # 2
KENOSHA WI
53142-2967
US

IV. Provider business mailing address

304 N PINE ST
MOUNT PROSPECT IL
60056-2441
US

V. Phone/Fax

Practice location:
  • Phone: 262-789-1191
  • Fax:
Mailing address:
  • Phone: 847-707-6633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number277002683
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number14330
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: