Individual
LISA COSTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
20 WINTER ST, PEMBROKE, MA 02359-4965
(781) 887-7377
Mailing address
79 BARSTOW AVE, NORWELL, MA 02061-2831
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
197629
MA
363L00000X
Nurse Practitioner
197629
MA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN197629
MA
Other
Enumeration date
09/17/2019
Last updated
05/08/2025
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