Provider Demographics
NPI:1033532601
Name:COSTABILE-LOPEZ, LAUREN ANN (FNP-BC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ANN
Last Name:COSTABILE-LOPEZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ANN
Other - Last Name:COSTABILE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3 WHITE PINE CT
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-1615
Mailing Address - Country:US
Mailing Address - Phone:914-362-0411
Mailing Address - Fax:
Practice Address - Street 1:3 WHITE PINE CT
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-1615
Practice Address - Country:US
Practice Address - Phone:914-362-0411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-01
Last Update Date:2024-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF353749-01363LF0000X
NY551079-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse