Provider Demographics
NPI:1215056684
Name:COSBY, LYNETTE
Entity type:Individual
Prefix:
First Name:LYNETTE
Middle Name:
Last Name:COSBY
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 1:333 WASHINGTON AVE N
Mailing Address - Street 2:STE 5000
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401-1377
Mailing Address - Country:US
Mailing Address - Phone:612-659-7111
Mailing Address - Fax:612-659-7101
Practice Address - Street 1:1243 W 79TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-3709
Practice Address - Country:US
Practice Address - Phone:773-488-0844
Practice Address - Fax:773-994-4610
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.006404363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily