MEDICARE: DR. DOROTHY KOZAKOWSKI DNP, APN

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	363L00000X	Nurse Practitioner	14330	WI
2	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	277002683	IL
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	14330	WI

General Provider Information

NPI Number	:	1588909196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOROTHY KOZAKOWSKI DNP, APN

Provider Business Mailing Address
First Line	:	4800 N SCOTTSDALE RD STE 2500
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-7630
Country	:	US
Telephone Number	:	262-999-3495
Fax Number	:

Provider Business Practice Location Address
First Line	:	6525 GREEN BAY RD # 2
Second Line	:
City	:	KENOSHA
State	:	WI
Zip	:	53142-2967
Country	:	US
Telephone Number	:	262-999-3495
Fax Number	:

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

Provider Enumeration Date	:	12/07/2012
Last Update Date	:	05/22/2026

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