Provider Demographics
NPI:1861479982
Name:COSTA, SUSAN D
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:D
Last Name:COSTA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:MYKUT
Other - Last Name:COSTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN CNOR RNFA
Mailing Address - Street 1:850 WALNUT BOTTOM RD
Mailing Address - Street 2:BELVEDERE MEDICAL CORPORATION
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-3698
Mailing Address - Country:US
Mailing Address - Phone:717-243-2244
Mailing Address - Fax:717-243-4618
Practice Address - Street 1:850 WALNUT BOTTOM RD
Practice Address - Street 2:BELVEDERE MEDICAL CORPORATION
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-3698
Practice Address - Country:US
Practice Address - Phone:717-243-2244
Practice Address - Fax:717-243-4618
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN313103L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse