Provider Demographics
NPI:1265718902
Name:COSTA, LYDIA CHRISTINA (LPN)
Entity type:Individual
Prefix:MS
First Name:LYDIA
Middle Name:CHRISTINA
Last Name:COSTA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH
Mailing Address - State:MA
Mailing Address - Zip Code:02769-0070
Mailing Address - Country:US
Mailing Address - Phone:508-496-9220
Mailing Address - Fax:774-565-0848
Practice Address - Street 1:36 WOODLAND WAY
Practice Address - Street 2:
Practice Address - City:REHOBOTH
Practice Address - State:MA
Practice Address - Zip Code:02769-1814
Practice Address - Country:US
Practice Address - Phone:508-496-9220
Practice Address - Fax:774-565-0848
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN20726164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse