1346435807 NPI number — MRS. NANCY LYNN COSTEN APNP/RN/MSN

Table of content: MRS. NANCY LYNN COSTEN APNP/RN/MSN (NPI 1346435807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346435807 NPI number — MRS. NANCY LYNN COSTEN APNP/RN/MSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COSTEN
Provider First Name:
NANCY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APNP/RN/MSN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MURPHY
Provider Other First Name:
NANCY
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APNP/RN/MSN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1346435807
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 DULANEY VALLEY ROAD, SUITE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOWNSON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-296-3104
Provider Business Mailing Address Fax Number:
410-296-3184

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4532 I-30
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MESQUITE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-324-8625
Provider Business Practice Location Address Fax Number:
214-324-8629
Provider Enumeration Date:
09/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  AP128186 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X , with the licence number: 3140-033 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 114204-030 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 36044500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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