Individual
HALEY D KOSTECKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
318 US HIGHWAY 51 N, DONGOLA, IL 62926-1103
(618) 827-3545
(618) 833-4891
Mailing address
513 N MAIN ST, ANNA, IL 62906-1668
(618) 833-4471
(618) 833-6267
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.005612
IL
Other
Enumeration date
10/01/2015
Last updated
04/25/2016
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