Provider Demographics
NPI:1699091470
Name:KOZAK, SANDRA KATHRYN (LPN)
Entity type:Individual
Prefix:MISS
First Name:SANDRA
Middle Name:KATHRYN
Last Name:KOZAK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-3512
Mailing Address - Country:US
Mailing Address - Phone:724-223-7801
Mailing Address - Fax:724-223-7802
Practice Address - Street 1:289 NORTH AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-3512
Practice Address - Country:US
Practice Address - Phone:724-223-7801
Practice Address - Fax:724-223-7802
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN274835164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse