Individual
CAROLYN CHAY COSTILOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1100 BELK BLVD, OXFORD, MS 38655-5242
(662) 636-1000
Mailing address
124 BRECKENRIDGE DR, OXFORD, MS 38655-7502
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
141317
MS
Other
Enumeration date
08/24/2021
Last updated
03/14/2023
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