Provider Demographics
NPI:1720233471
Name:DICOSTANZO, BEATRICE MARY (GNP)
Entity Type:Individual
Prefix:
First Name:BEATRICE
Middle Name:MARY
Last Name:DICOSTANZO
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 THE GLN
Mailing Address - Street 2:
Mailing Address - City:TAMIMENT
Mailing Address - State:PA
Mailing Address - Zip Code:18371-9716
Mailing Address - Country:US
Mailing Address - Phone:570-588-7766
Mailing Address - Fax:
Practice Address - Street 1:221 E BROWN ST
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3005
Practice Address - Country:US
Practice Address - Phone:570-421-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-22
Last Update Date:2008-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008981363LG0600X
NYF340298-1363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology