Individual
MRS. THAO L COSTANZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGPCNP
Contact information
Practice address
110 FRANCIS ST, BOSTON, MA 02215-5501
(617) 632-7246
Mailing address
153 VINE ST, EVERETT, MA 02149-4827
(857) 363-8776
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
RN2267066
MA
363LG0600X
Gerontology Nurse Practitioner
Primary
RN2267066
MA
Other
Enumeration date
12/26/2017
Last updated
11/01/2024
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