Individual
KATHRYN COSTELLO
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
700 24TH ST, FORT LEE, VA 23801-1716
(804) 734-9295
(804) 734-9016
Mailing address
700 24TH ST, FORT LEE, VA 23801-1716
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
0024087895
VA
Other
Enumeration date
10/18/2005
Last updated
07/08/2007
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