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NPI Code Detail

MEDICARE: NAZARE COSTA RN BSN CNOR RNFA

MEDICARE: NAZARE COSTA RN BSN CNOR RNFA
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
1163WR0006XRegistered Nurse First Assistant26NR21074800NJ

General Provider Information

NPI Number : 1649000571
Entity Type Code : Individual
Provider Name (Legal Business Name) : NAZARE COSTA RN BSN CNOR RNFA
Provider Business Mailing Address
First Line : 44 VETERANS MEMORIAL DR E APT 209
Second Line :
City : SOMERVILLE
State : NJ
Zip : 08876-2985
Country : US
Telephone Number : 732-447-7151
Fax Number :
Provider Business Practice Location Address
First Line : 110 REHILL AVE
Second Line :
City : SOMERVILLE
State : NJ
Zip : 08876-2519
Country : US
Telephone Number : 908-685-2200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2024
Last Update Date : 08/05/2024

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