Provider Demographics
NPI:1437476389
Name:WORTHAM-COSTON, DANETTE LETAE (RN)
Entity Type:Individual
Prefix:MS
First Name:DANETTE
Middle Name:LETAE
Last Name:WORTHAM-COSTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 SELYE TER
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14613-1729
Mailing Address - Country:US
Mailing Address - Phone:585-458-7156
Mailing Address - Fax:
Practice Address - Street 1:171 SELYE TER
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14613-1729
Practice Address - Country:US
Practice Address - Phone:585-458-7156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY554007163W00000X, 163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163W00000XNursing Service ProvidersRegistered Nurse