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General NPI Number Information
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NPI Number | 1275100083
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Entity Type | Individual
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Provider Name | LISA KOSSE RN
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Gender | Female
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Dates
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Enumeration Date | 06/09/2021
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Last Update Date | 06/09/2021
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Provider Practice Location Address
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Address Line | 1050 NEAL ZICK RD
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City | WILLARD
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State | OH
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Zip | 44890-9288
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Country | US
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Telephone | 419-935-6511
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Fax |
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Provider Business Mailing Address
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Address Line | 1 TIMOTHY AVE
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City | WILLARD
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State | OH
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Zip | 44890-1632
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Country | US
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Telephone | 419-933-3058
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Fax |
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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 | 364SL0600X
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Taxonomy Name | Long-Term Care Clinical Nurse Specialist
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License Number | RN319347
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License Number State | OH
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