Basic Information
| Provider Information | |||||||||
| NPI: | 1255602108 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOSKO | ||||||||
| FirstName: | AINE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | NURSE PRACTITIONER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1234 MCHENRY AVE | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953505373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2096018439 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1234 MCHENRY AVE | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953505373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095442554 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2012 | ||||||||
| LastUpdateDate: | 01/24/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 661809 | CA | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 21495 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.