Individual
NUSIRATU TITILAYO COSBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
4401 E 10TH ST, INDIANAPOLIS, IN 46201-2744
(317) 353-0195
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
28165047A
IN
363LF0000X
Family Nurse Practitioner
71004815A
IN
363LG0600X
Gerontology Nurse Practitioner
Primary
71004815A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001224860
ANTHEM PTAN
IN
01
—
068010466
MEDICARE PTAN
IN
05
—
201212780
—
IN
01
—
IN2614024
MEDICARE PTAN
IN
01
—
P02382155
RAILROAD PTAN
IN
Enumeration date
01/28/2014
Last updated
08/09/2024
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