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General NPI Number Information
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NPI Number | 1124513114
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Entity Type | Individual
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Provider Name | GINA S. KOZUL
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Gender | Female
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Dates
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Enumeration Date | 06/22/2018
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 18555 N 79TH AVE BLDG C
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City | GLENDALE
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State | AZ
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Zip | 85308-8370
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Country | US
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Telephone | 623-776-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 7301 N 16TH ST STE 102
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City | PHOENIX
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State | AZ
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Zip | 85020-5266
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Country | US
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Telephone | 480-420-4027
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Fax | 602-535-0640
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | CRNA1540
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License Number State | AZ
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