Individual
JENNY KOSHY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
5 N MAIN ST, ENFIELD, CT 06082-3372
(860) 347-6971
(860) 343-7379
Mailing address
245 S GARY AVE, SUITE 100, BLOOMINGDALE, IL 60108-2228
(630) 924-4009
(630) 924-9671
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209011753
IL
363LF0000X
Family Nurse Practitioner
Primary
11880
CT
363LF0000X
Family Nurse Practitioner
209011753
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
346761379001
—
IL
01
—
920540
MEDICARE PTAN (GROUP)
IL
01
—
F400169410
MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
08/27/2014
Last updated
06/22/2023
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