Provider Demographics
NPI:1083816144
Name:COSTON, DAWN MARIE (CRNP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:COSTON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 W LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-7253
Mailing Address - Country:US
Mailing Address - Phone:205-226-5900
Mailing Address - Fax:205-226-5937
Practice Address - Street 1:35 W LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-7253
Practice Address - Country:US
Practice Address - Phone:205-226-5900
Practice Address - Fax:205-226-5937
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-083534363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL891017562Medicaid
AL891017563Medicaid
AL051541079OtherBCBS
AL051541075OtherBCBS
AL051541075Medicare PIN