Provider Demographics
NPI:1205688801
Name:COSTNER, SABRINA
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:COSTNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4891 E BRITAIN AVE
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-9731
Mailing Address - Country:US
Mailing Address - Phone:269-487-0744
Mailing Address - Fax:
Practice Address - Street 1:637 N WELLS AVE
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-7711
Practice Address - Country:US
Practice Address - Phone:269-332-9841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5574025253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care