Provider Demographics
NPI:1831556810
Name:COSTNER, CLAUDIA RACHELLE
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:RACHELLE
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 1:139 HEDWIG AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14211-2835
Mailing Address - Country:US
Mailing Address - Phone:716-247-1055
Mailing Address - Fax:
Practice Address - Street 1:139 HEDWIG AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14211-2835
Practice Address - Country:US
Practice Address - Phone:716-247-1055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY322476-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse