Provider Demographics
NPI:1184726093
Name:DICOSTANZO, RHONDA JEAN (CNM/ARNP)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:JEAN
Last Name:DICOSTANZO
Suffix:
Gender:F
Credentials:CNM/ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 S J ST
Mailing Address - Street 2:STE 120
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4964
Mailing Address - Country:US
Mailing Address - Phone:253-207-4890
Mailing Address - Fax:253-207-4871
Practice Address - Street 1:1812 S J ST
Practice Address - Street 2:STE 120
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4964
Practice Address - Country:US
Practice Address - Phone:253-207-4890
Practice Address - Fax:253-207-4871
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00144184163W00000X
WAAP30006812367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0215241OtherSTATE L&I
WA1043186Medicaid
WA8942677OtherSTATE CRIME VICTIMS
WA9650557Medicaid
WAP00396729OtherRAILROAD
WA0215241OtherSTATE L&I