Provider Demographics
NPI:1144284407
Name:COSNER, GINA MARIE (RD)
Entity type:Individual
Prefix:MS
First Name:GINA
Middle Name:MARIE
Last Name:COSNER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7445 ALLEN RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-1963
Mailing Address - Country:US
Mailing Address - Phone:313-382-0505
Mailing Address - Fax:313-382-1584
Practice Address - Street 1:7445 ALLEN RD
Practice Address - Street 2:SUITE 210
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-1963
Practice Address - Country:US
Practice Address - Phone:313-382-0505
Practice Address - Fax:313-382-1584
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIR468299133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIR468299OtherSTATE LICENSE
MIR468299OtherSTATE LICENSE