MEDICARE: KRISTA COSTANTINO

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	364SA2200X	Adult Health Clinical Nurse Specialist	272055-01	NY
2	364SP0200X	Pediatric Clinical Nurse Specialist	272055-01	NY
3	164W00000X	Licensed Practical Nurse	272055-1	NY

General Provider Information

NPI Number	:	1558664490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA COSTANTINO

Provider Business Mailing Address
First Line	:	7247 WARD RD
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-1437
Country	:	US
Telephone Number	:	716-245-8306
Fax Number	:

Provider Business Practice Location Address
First Line	:	7247 WARD RD
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-1437
Country	:	US
Telephone Number	:	716-245-8306
Fax Number	:

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

Provider Enumeration Date	:	12/15/2010
Last Update Date	:	06/12/2023

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