Provider Demographics
NPI:1306254388
Name:THOMAS, COZETTE ANTONETTE
Entity type:Individual
Prefix:MS
First Name:COZETTE
Middle Name:ANTONETTE
Last Name:THOMAS
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 1:1128 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-3528
Mailing Address - Country:US
Mailing Address - Phone:231-286-3746
Mailing Address - Fax:
Practice Address - Street 1:1128 WOOD ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-3528
Practice Address - Country:US
Practice Address - Phone:231-286-3746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker