Individual
EMILY ANN COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1730 W 25TH ST, CLEVELAND, OH 44113-3108
(216) 696-4300
Mailing address
2012 WILLEY AVE, CLEVELAND, OH 44113-4200
(724) 866-1281
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN407668
OH
367500000X
Certified Registered Nurse Anesthetist
Primary
129051
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
MEDICARE PTAN
OH
05
—
PENDING
—
OH
Enumeration date
01/07/2020
Last updated
05/07/2025
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