Provider Demographics
NPI:1215459151
Name:KOSLEY, LISA MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:KOSLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:GOBROGGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2857 RIVIERA DR STE 202
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3469
Mailing Address - Country:US
Mailing Address - Phone:330-606-9561
Mailing Address - Fax:866-354-6211
Practice Address - Street 1:2857 RIVIERA DR STE 202
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3469
Practice Address - Country:US
Practice Address - Phone:330-606-9561
Practice Address - Fax:866-354-6211
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.348879163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health