| NPI | 1780048561 |
|---|---|
| Former Name | COLLEEN COSTELLO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71009869A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71009869A) |
| 363L00000X Nurse Practitioner (Licence: IL 209-014187) | |
| 363LF0000X Nurse Practitioner, Family (Licence: IL 209014187) | |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2025-04-10 |