Provider Demographics
NPI:1144539990
Name:DACOSTA, HELEN JEANETTE (LPN)
Entity type:Individual
Prefix:MS
First Name:HELEN
Middle Name:JEANETTE
Last Name:DACOSTA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 EMERSON ST
Mailing Address - Street 2:APARTMENT 1
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14613-2504
Mailing Address - Country:US
Mailing Address - Phone:585-287-7796
Mailing Address - Fax:
Practice Address - Street 1:202 EMERSON ST
Practice Address - Street 2:APARTMENT 1
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14613-2504
Practice Address - Country:US
Practice Address - Phone:585-287-7796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188336164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse