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General NPI Number Information
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NPI Number | 1821479189
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Entity Type | Individual
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Provider Name | BRIANA KOZAK PA, RD
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Gender | Female
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Dates
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Enumeration Date | 06/12/2015
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Last Update Date | 04/03/2024
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Provider Practice Location Address
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Address Line | 3001 N GREEN BAY AVE
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City | NORTH CHICAGO
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State | IL
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Zip | 60064
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Country | US
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Telephone | 708-833-9174
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Fax |
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Provider Business Mailing Address
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Address Line | 6334 ELDERWOOD CT
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City | OAK FOREST
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State | IL
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Zip | 60452-1749
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Country | US
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Telephone | 708-833-9174
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085009992
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 164006332
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License Number State | IL
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