Basic Information
| Provider Information | |||||||||
| NPI: | 1699989798 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COSTE | ||||||||
| FirstName: | ANNE | ||||||||
| MiddleName: | BURKE | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 WALNUT ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191075509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159551234 | ||||||||
| FaxNumber: | 2159233504 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 WALNUT ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191075509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159551234 | ||||||||
| FaxNumber: | 2159236789 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2007 | ||||||||
| LastUpdateDate: | 05/20/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | SP009412 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 102896535 | 05 | PA | MEDICAID |