Individual
MRS. MARY A COSTELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
525 E 68TH ST STE M404, NEW YORK, NY 10065-4870
(212) 746-5156
Mailing address
160 W CAMINO REAL # 255, BOCA RATON, FL 33432-5942
(704) 252-1579
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
100193
WI
363LA2200X
Adult Health Nurse Practitioner
201508795NP-PP
OR
363LA2200X
Adult Health Nurse Practitioner
5004075
NC
363LA2200X
Adult Health Nurse Practitioner
C-APN.0001649-C-NP
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100223521
—
WI
05
—
7004305
—
NC
05
—
NP1325
—
SC
Enumeration date
07/31/2008
Last updated
01/18/2024
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