Costa, Maxine

Costa, Maxine is an individual health care provider with primary practice located at 19 Woodland Street Suite 31, Hartford CT 06105. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Women's Health, Physician Assistants & Advanced Practice Nursing Providers / Obstetrics & Gynecology. Physician Assistants & Advanced Practice Nursing Providers / Obstetrics & Gynecology is her primary health care specialty. Costa, Maxine can be contacted via phone (860) 728-1212.

Contact Information

Primary practice address
19 Woodland Street Suite 31 Hartford CT 06105
Phone: (860) 728-1212
Fax: (860) 724-5224
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Women's Health 364SW0102X 000861 Connecticut
Physician Assistants & Advanced Practice Nursing Providers / Obstetrics & Gynecology 363LX0001X 000861 Connecticut

Profile Details

NPI number 1851494942
LBN Legal business name Costa, Maxine
Credentials Advanced Practice Registered Nurse (APRN)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 6th, 2006
Last updated Jan 11th, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1851494942 NPPES
Connecticut MEDICAID 004207719

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