NPI | 1649288440 |
---|---|
Former Name | KRISTEN MARIE COSTELLO |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH NP07195) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN 286828) |
Enumeration Date | 2006-08-04 |
Last Update Date | 2014-06-02 |