Basic Information
| Provider Information | |||||||||
| NPI: | 1548749682 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COSTA | ||||||||
| FirstName: | KATHARINE | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN, NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 39 EAST AVE | ||||||||
| Address2: | |||||||||
| City: | PAWTUCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028604003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013166345 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1000 BROAD ST | ||||||||
| Address2: | |||||||||
| City: | CENTRAL FALLS | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028631507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017220081 | ||||||||
| FaxNumber: | 4013120318 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2018 | ||||||||
| LastUpdateDate: | 06/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0200X | RN63417 | RI | N | Nursing Service Providers | Registered Nurse | Pediatrics | 163WP0200X | 926479 | TX | N | Nursing Service Providers | Registered Nurse | Pediatrics | 363LP0200X | APRN02106 | RI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.