Provider Demographics
NPI:1730526799
Name:COZAD, SHANNAH KATHLEEN (ARNP)
Entity type:Individual
Prefix:
First Name:SHANNAH
Middle Name:KATHLEEN
Last Name:COZAD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 WESTERLY DR
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-1232
Mailing Address - Country:US
Mailing Address - Phone:360-580-8441
Mailing Address - Fax:
Practice Address - Street 1:503 WESTERLY DR
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-1232
Practice Address - Country:US
Practice Address - Phone:360-580-8441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00150724163WP0808X
WAAP60399114363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health