Provider Demographics
NPI:1174991764
Name:COSENZA, ERIN MARIE
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:MARIE
Last Name:COSENZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 VENICE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-4064
Mailing Address - Country:US
Mailing Address - Phone:313-689-7710
Mailing Address - Fax:
Practice Address - Street 1:1520 VENICE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4064
Practice Address - Country:US
Practice Address - Phone:313-689-7710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-13
Last Update Date:2015-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other