Individual
IRA KOSTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
212 GLEN ELLYN RD APT 104, BLOOMINGDALE, IL 60108-1846
(646) 287-7951
Mailing address
212 GLEN ELLYN RD APT 104, BLOOMINGDALE, IL 60108-1846
(646) 287-7951
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
0024178863
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
0024178863
VA
Other
Enumeration date
11/08/2019
Last updated
01/22/2026
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