Individual
JACQUELINE R COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, APRN, CPNP
Contact information
Practice address
1801 GLENDALE DR SW, WILSON, NC 27893-4499
(252) 237-3141
Mailing address
1801 GLENDALE DR SW, WILSON, NC 27893-4499
(252) 237-3141
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
5006348
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003850405
—
NC
Enumeration date
06/15/2006
Last updated
02/12/2026
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