Provider Demographics
NPI:1992169577
Name:KOSOW, CONSTANCE LEE
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:LEE
Last Name:KOSOW
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 1:9 BROWN RD
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-3707
Mailing Address - Country:US
Mailing Address - Phone:607-259-0575
Mailing Address - Fax:
Practice Address - Street 1:9 BROWN RD
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-3707
Practice Address - Country:US
Practice Address - Phone:607-259-0575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315499-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse