Provider Demographics
NPI:1649782533
Name:COSENTINO, MARY ANN (NP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:COSENTINO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3087 OLDE WINTER TRL
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44514-0001
Mailing Address - Country:US
Mailing Address - Phone:330-502-5600
Mailing Address - Fax:
Practice Address - Street 1:1 UNIVERSITY PLZ
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44555-0001
Practice Address - Country:US
Practice Address - Phone:330-941-3489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH161473363LP0200X, 163WC1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WC1400XNursing Service ProvidersRegistered NurseCollege Health