Provider Demographics
NPI:1619355260
Name:DECOSTA, DAWN (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:DECOSTA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 NORTHEASTERN BLVD STE 10A
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-3142
Mailing Address - Country:US
Mailing Address - Phone:603-945-5532
Mailing Address - Fax:603-577-1679
Practice Address - Street 1:40 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4006
Practice Address - Country:US
Practice Address - Phone:603-226-7505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-15
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH065101-21163WP0808X
NH065101-23363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health