Individual
MRS. JACQUELYN ANN COSTABILO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
1 VETERANS DR, MINNEAPOLIS, MN 55417-2309
(612) 467-4295
(612) 727-5997
Mailing address
10995 OAK GROVE CIR UNIT B, WOODBURY, MN 55129-8727
(651) 436-3761
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2353
MN
Other
Enumeration date
07/30/2006
Last updated
07/08/2007
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