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NPI Code Detail

MEDICARE: BRANDY KOCISKO-MULLETT RN

MEDICARE: BRANDY KOCISKO-MULLETT RN
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
1163WP0808XPsychiatric/Mental Health Registered NurseRN.417056OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11306109558OTHEROHNPI

General Provider Information

NPI Number : 1700420544
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDY KOCISKO-MULLETT RN
Provider Business Mailing Address
First Line : 925 KEYNOTE CIR STE 300
Second Line :
City : BROOKLYN HTS
State : OH
Zip : 44131-1869
Country : US
Telephone Number : 216-931-1300
Fax Number :
Provider Business Practice Location Address
First Line : 925 KEYNOTE CIR STE 300
Second Line :
City : BROOKLYN HTS
State : OH
Zip : 44131-1869
Country : US
Telephone Number : 216-931-1300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2019
Last Update Date : 11/05/2019

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