| NPI | 1437275252 |
|---|---|
| Former Name | NANCY COSTELLO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: IL 085002020) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MO 2011035522) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2018-09-12 |