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Individual

BRENDA LEE COSTELLO-WELLS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CNS APRN

Contact information

Practice address
1500 N RITTER AVE, INDIANAPOLIS, IN 46219-3027
(317) 355-2560
(317) 355-2418
Mailing address
6626 E 75TH STREET, STE 500, INDIANAPOLIS, IN 46250-2890
(317) 621-7561
(317) 355-6096

Taxonomy

Speciality
Code
Description
License number
State
364SP0807X
Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
Primary
70000059A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100270530
IN
05
200223310
IN
Enumeration date
07/13/2005
Last updated
11/27/2023
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