Lydia Christina Costa, LPN

Individual provider Active NPI Licensed Practical Nurse · Rehoboth, MA

NPI 1265718902 · NPPES record last updated Oct 26, 2011

Key facts

NPI
1265718902
Entity type
Individual (NPI type 1)
Primary specialty
Licensed Practical Nurse 164W00000X
License
LN20726 (MA)
Practice address
36 Woodland Way
Rehoboth, MA 02769-1814
Phone
(508) 496-9220
Fax
(774) 565-0848
NPI assigned
Oct 26, 2011
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
LN20726MAMDLicensed Practical Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X LN20726 MA Yes

Addresses

Primary practice location

36 Woodland Way
Rehoboth, MA 02769-1814

Mailing address

PO Box 70
Rehoboth, MA 02769-0070
Phone (508) 496-9220

Other providers in Rehoboth, MA

All providers in Rehoboth, MA · Licensed Practical Nurse in Massachusetts

Sources for this page

Verify at the official NPI Registry.