Individual
ADRIENNE IDA DECOSTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
303 LANSDOWNE AVE, CARLE PLACE, NY 11514-2030
(631) 664-4682
Mailing address
303 LANSDOWNE AVE, CARLE PLACE, NY 11514-2030
(631) 664-4682
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
210049
NY
Other
Enumeration date
06/06/2017
Last updated
07/21/2022
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