MEDICARE: MARJORIE S KOZA CRNA

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	R29654	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487618534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARJORIE S KOZA CRNA

Provider Business Mailing Address
First Line	:	PO BOX 2006
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87504-2006
Country	:	US
Telephone Number	:	505-690-4281
Fax Number	:

Provider Business Practice Location Address
First Line	:	602 AVENIDA CELAYA
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87506-3439
Country	:	US
Telephone Number	:	505-690-4281
Fax Number	:

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

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	10/14/2011

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