Lori Costanza

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

4704238940 Issued in MI

Practice address

4768 River Rd
Sodus, MI 49126-9789

Phone

(269) 983-0300

NPI assigned

Nov 23, 2020

Last updated

Nov 23, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Powell House Afc

  • Adult Care Home Facility
  • Saint Joseph, MI
  • NPI 1811771488
  NPD Authorized official
• Private Duty Transportation LLC

  • Non-emergency Medical Transport (VAN)
  • Saint Joseph, MI
  • NPI 1740916428
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1606089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606089600000",
    "number": "1184228959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4768 RIVER RD",
            "city": "SODUS",
            "state": "MI",
            "postal_code": "491269789",
            "telephone_number": "269-983-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4768 RIVER RD",
            "city": "SODUS",
            "state": "MI",
            "postal_code": "491269789",
            "telephone_number": "269-983-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTANZA",
        "first_name": "LORI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-23",
        "last_updated": "2020-11-23",
        "certification_date": "2020-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704238940",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Great Lakes Medi-Van, LLC.
• Tom Krzysiak

• Registered Nurse in Sodus, MI
• Providers in Sodus, MI by specialty
• Registered Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.