Provider Demographics
NPI:1285489534
Name:KOZUSKO, AMAYA JENN (MS, FNP-C)
Entity type:Individual
Prefix:
First Name:AMAYA
Middle Name:JENN
Last Name:KOZUSKO
Suffix:
Gender:F
Credentials:MS, FNP-C
Other - Prefix:
Other - First Name:AMAYA
Other - Middle Name:JENN
Other - Last Name:ABADIA-MANTHEI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:310 PARSONS DR APT 403
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-3224
Mailing Address - Country:US
Mailing Address - Phone:781-492-9136
Mailing Address - Fax:
Practice Address - Street 1:302 HUSSON AVE STE 2
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3373
Practice Address - Country:US
Practice Address - Phone:207-941-2373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-20
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP241106363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily