MEDICARE: GINA S. KOZUL

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	CRNA1540	AZ

General Provider Information

NPI Number	:	1124513114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA S. KOZUL

Provider Business Mailing Address
First Line	:	7301 N 16TH ST STE 102
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-5266
Country	:	US
Telephone Number	:	480-420-4027
Fax Number	:	602-535-0640

Provider Business Practice Location Address
First Line	:	18555 N 79TH AVE BLDG C
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-8370
Country	:	US
Telephone Number	:	623-776-2500
Fax Number	:

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

Provider Enumeration Date	:	06/22/2018
Last Update Date	:	09/05/2024

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Directions to “ GINA S. KOZUL ” Practice Location

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