Individual
JENNIFER COSTELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5718 SPANISH DAWN, SAN ANTONIO, TX 78222-3470
(210) 708-7097
Mailing address
5718 SPANISH DAWN, SAN ANTONIO, TX 78222-3470
(210) 708-7097
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
782080
TX
Other
Enumeration date
08/19/2018
Last updated
08/19/2018
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