Individual
MACKENZIE COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
1630 MAIN ST STE 101, CHESTER, MD 21619-2792
(410) 604-6560
(410) 643-5789
Mailing address
1630 MAIN ST STE 101, CHESTER, MD 21619-2792
(410) 604-6560
(410) 643-5789
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN1033652
DC
363LF0000X
Family Nurse Practitioner
Primary
R227450
MD
Other
Enumeration date
05/11/2017
Last updated
08/26/2020
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