Provider Demographics
NPI:1396243762
Name:KOZIK, GRACE MIKHAILA (APRN)
Entity type:Individual
Prefix:MS
First Name:GRACE
Middle Name:MIKHAILA
Last Name:KOZIK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05033-0338
Mailing Address - Country:US
Mailing Address - Phone:802-222-3026
Mailing Address - Fax:
Practice Address - Street 1:720 VILLAGE RD
Practice Address - Street 2:LITTLE RIVERS HEALTH CARE -EAST CORINTH
Practice Address - City:EAST CORINTH
Practice Address - State:VT
Practice Address - Zip Code:05040
Practice Address - Country:US
Practice Address - Phone:802-439-5321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2314177163W00000X
VT101.0134241363LF0000X, 363LP0808X
NH076421-23363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily