NPI | 1417630120 |
---|---|
Former Name | JENNIFER COSTELLO |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 163W00000X Registered Nurse (Licence: MA RN2317192) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA RN2317192) |
Enumeration Date | 2023-08-09 |
Last Update Date | 2024-06-11 |