Provider Demographics
NPI:1699304865
Name:COSHOW, ALEXANDRIA BRENNA (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:BRENNA
Last Name:COSHOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALEXANDRIA
Other - Middle Name:BRENNA
Other - Last Name:WIEDENMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3261 24TH AVE NW STE 101
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069
Mailing Address - Country:US
Mailing Address - Phone:405-364-6432
Mailing Address - Fax:
Practice Address - Street 1:3261 24TH AVE NW STE 101
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069
Practice Address - Country:US
Practice Address - Phone:405-364-6432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OK39501208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program