Individual
JENNIFER COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
911 W HUDSON BLVD, GASTONIA, NC 28052-6430
(704) 853-5464
Mailing address
911 W HUDSON BLVD, GASTONIA, NC 28052-6430
(704) 853-5464
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
229882
NC
Other
Enumeration date
09/06/2012
Last updated
09/06/2012
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