MEDICARE: DAVID MORERA COSTA NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	PMHNP	IL

General Provider Information

NPI Number	:	1427991769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID MORERA COSTA NP

Provider Business Mailing Address
First Line	:	410 KREBS DR
Second Line	:
City	:	CHAMPAIGN
State	:	IL
Zip	:	61822-1144
Country	:	US
Telephone Number	:	217-480-7484
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 KREBS DR
Second Line	:
City	:	CHAMPAIGN
State	:	IL
Zip	:	61822-1144
Country	:	US
Telephone Number	:	217-480-7484
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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