Provider Demographics
NPI:1154161560
Name:KOZUSKO, BROOKE
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:KOZUSKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11970 HAMBY HILL RD
Mailing Address - Street 2:
Mailing Address - City:FRAZEYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43822-9368
Mailing Address - Country:US
Mailing Address - Phone:740-507-2429
Mailing Address - Fax:
Practice Address - Street 1:125 CONN DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-7930
Practice Address - Country:US
Practice Address - Phone:740-507-2429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker