| Doctor Name: | LETY ELIZABETH COSTA |
| NPI Number: | 1821188269 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PAC |
| License Number: | 110879 |
| Business Practice Address: | 807 North Ash Gordon, NE - 693431132 |
| Business Phone Number: | 3082822200 |
| Business Fax Number: | 3082821428 |
| Mailing Address: | 300 East 8th, GORDON |
| State: | NE |
| Postal Code: | 693431123 |
| Phone Number: | 3082820401 |
| Fax Number: | 3082820431 |
| NPI Enumeration Date: | 10/14/2006 |
| NPI Last Update Date: | 09/23/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 110879 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NE |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |