Individual
MAXINE COSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
19 WOODLAND STREET, SUITE 31, HARTFORD, CT 06105
(860) 728-1212
(860) 724-5224
Mailing address
19 WOODLAND STREET, SUITE 31, HARTFORD, CT 06105
(860) 728-1212
(860) 724-5224
Taxonomy
Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
000861
CT
364SW0102X
Women's Health Clinical Nurse Specialist
000861
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004207719
—
CT
Enumeration date
09/06/2006
Last updated
01/11/2010
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