Provider Demographics
NPI:1144509373
Name:KOSCH, VICKY JILL (RN)
Entity type:Individual
Prefix:MRS
First Name:VICKY
Middle Name:JILL
Last Name:KOSCH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 SOUTH 14TH STREET
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80807-1327
Mailing Address - Country:US
Mailing Address - Phone:719-346-7158
Mailing Address - Fax:719-346-8066
Practice Address - Street 1:252 S 14TH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80807-2321
Practice Address - Country:US
Practice Address - Phone:719-346-7158
Practice Address - Fax:719-346-8066
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO191572163W00000X
KS13-108546-092163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse