Individual
RUTH COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, CRNA
Contact information
Practice address
111 FOUNDERS PLZ, #300 C/O IPMS, EAST HARTFORD, CT 06108-3212
(860) 282-4137
(890) 282-0170
Mailing address
111 FOUNDERS PLZ, #300 C/O IPMS, EAST HARTFORD, CT 06108-3212
(860) 282-4137
(890) 282-0170
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
002457
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004211348
—
CT
Enumeration date
03/22/2006
Last updated
11/14/2017
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