Most Relevant Information
Provider Data
| NPI Number: | 1003374588 |
| Provider Name: | NICOLE KOSMIDER |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/04/2019 |
| Last Updated: | 05/21/2021 |
Provider Practice Location
300 BOULDER FALLS DR APT I334
LEBANON
OR
973552884
Practice Location Phone/Fax
| Phone: | 9734528145 |
| Fax: |
Provider Mailing Location
111 COLCHESTER AVE
BURLINGTON
VT
054011473
Provider Mailing Phone/Fax
| Phone: | 8028470000 |
| Fax: |