Provider Demographics
NPI:1093595670
Name:COSTON, PAULINE
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:COSTON
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 1:276 EASTWOOD LN SE
Mailing Address - Street 2:
Mailing Address - City:BELVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28451-9561
Mailing Address - Country:US
Mailing Address - Phone:910-685-3748
Mailing Address - Fax:
Practice Address - Street 1:276 EASTWOOD LN SE
Practice Address - Street 2:
Practice Address - City:BELVILLE
Practice Address - State:NC
Practice Address - Zip Code:28451-9561
Practice Address - Country:US
Practice Address - Phone:910-685-3748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program