Provider Demographics
NPI:1063194124
Name:COSMA, EMILY G (CLS)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:G
Last Name:COSMA
Suffix:
Gender:F
Credentials:CLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 N HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-2024
Mailing Address - Country:US
Mailing Address - Phone:234-567-7340
Mailing Address - Fax:
Practice Address - Street 1:940 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:OH
Practice Address - Zip Code:44420-2024
Practice Address - Country:US
Practice Address - Phone:234-567-7340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN