Provider Demographics
NPI:1972211688
Name:COSBY, CHASITY
Entity type:Individual
Prefix:
First Name:CHASITY
Middle Name:
Last Name:COSBY
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 1:2001 HUNTMASTER DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-3497
Mailing Address - Country:US
Mailing Address - Phone:618-803-5788
Mailing Address - Fax:
Practice Address - Street 1:2001 HUNTMASTER DR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-3497
Practice Address - Country:US
Practice Address - Phone:618-803-5788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula