Provider Demographics
NPI:1992340731
Name:KOSTIAK, EMMA ROSE (BSN, RN)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:ROSE
Last Name:KOSTIAK
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 SPRING RUN DR
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3395
Mailing Address - Country:US
Mailing Address - Phone:570-351-2689
Mailing Address - Fax:
Practice Address - Street 1:3500 VICTORIA ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2543
Practice Address - Country:US
Practice Address - Phone:888-747-0794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-15
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN638384367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered