Individual
ELLEN KOSECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
480 CENTRAL AVE, PEARL HARBOR, HI 96860-4908
(808) 257-3365
Mailing address
480 CENTRAL AVE, PEARL HARBOR, HI 96860-4908
(808) 257-3365
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12353304-1206
UT
363A00000X
Physician Assistant
12353304-8906
UT
Other
Enumeration date
03/27/2021
Last updated
02/21/2024
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