License holder summary

KATY SUZANNE COSTA is a Board Of Medicine licensed to practice in Idaho. The address on file for KATY SUZANNE COSTA is 10803 W LAKE HAZEL RD BOISE ID 83709. This licensed professional license is not current. The license was granted 06/24/2004 and expired on 08/01/2016.

Idaho

Division of Occupational and Professional Licenses

KATY SUZANNE COSTA
Board Of Medicine
License number
LRT-1062
Date granted
06/24/2004
Date expires
08/01/2016
Class
Board Of Medicine
Status
Canceled
Address
10803 W LAKE HAZEL RD BOISE ID 83709
idaholicensing.com
ID 48361499
LAST UPDATED 2024-02-18 00:58:57 UTC

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