Provider Demographics
NPI:1427705326
Name:KOZENIEWSKI, MICHELLE (MSN, RN, CPNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:KOZENIEWSKI
Suffix:
Gender:F
Credentials:MSN, RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 2ND ST APT 402
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1135
Mailing Address - Country:US
Mailing Address - Phone:215-527-1912
Mailing Address - Fax:
Practice Address - Street 1:7100 VAN NUYS BLVD STE 110
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3063
Practice Address - Country:US
Practice Address - Phone:818-205-1666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019890208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics