Provider Demographics
NPI:1609530302
Name:COSTE, LISA ANN (RN, LAC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:COSTE
Suffix:
Gender:F
Credentials:RN, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 CALLE ESPERANZA
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2372
Mailing Address - Country:US
Mailing Address - Phone:520-249-6856
Mailing Address - Fax:
Practice Address - Street 1:4755 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2449
Practice Address - Country:US
Practice Address - Phone:520-458-3932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN91983163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No163W00000XNursing Service ProvidersRegistered Nurse