Basic Information
| Provider Information | |||||||||
| NPI: | 1457498065 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COSSMAN | ||||||||
| FirstName: | CHANAH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CNM, NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 829 F ST | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937063418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592660444 | ||||||||
| FaxNumber: | 5592667745 | ||||||||
| Practice Location | |||||||||
| Address1: | 829 F ST | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937063418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592660444 | ||||||||
| FaxNumber: | 5592667745 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 363L00000X | NP 5455 | CA | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 367A00000X | NMW 802 | CA | X | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | NMW008020 | 05 | CA | MEDICAID |