Provider Demographics
NPI:1063226751
Name:KOSENA, ALLIE (WHNP-BC)
Entity type:Individual
Prefix:
First Name:ALLIE
Middle Name:
Last Name:KOSENA
Suffix:
Gender:
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:ALLIE
Other - Middle Name:
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26258 N 43RD PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-8913
Mailing Address - Country:US
Mailing Address - Phone:406-465-3839
Mailing Address - Fax:
Practice Address - Street 1:11209 N TATUM BLVD STE 255
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-6061
Practice Address - Country:US
Practice Address - Phone:602-468-3912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ319398163W00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse