MEDICARE: LANDEN ALYSE KOZLOWSKI RN, BSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	159405	MO
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1083505580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANDEN ALYSE KOZLOWSKI RN, BSN

Provider Business Mailing Address
First Line	:	3810 S JONATHAN AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-5683
Country	:	US
Telephone Number	:	409-656-1076
Fax Number	:

Provider Business Practice Location Address
First Line	:	1235 E CHEROKEE ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-2203
Country	:	US
Telephone Number	:	417-820-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2025
Last Update Date	:	05/13/2026

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