Individual
MEGHAN MARIE COSTELLO-ISHAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
4420 LAKE BOONE TRL, RALEIGH, NC 27607-7505
(919) 784-3034
Mailing address
PO BOX 18139, RALEIGH, NC 27619-8139
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
182618
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
3293
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8052662
—
NC
01
—
P00390256
RAILROAD-MEDICARE
NC
Enumeration date
10/20/2006
Last updated
06/11/2021
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