Individual
KENNETH W COSTNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1610 ORCHARD DR, CHAMBERSBURG, PA 17201-9206
(717) 261-0929
(717) 261-0902
Mailing address
785 5TH AVE, SUITE 3, CHAMBERSBURG, PA 17201-4232
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
69312
WV
363LF0000X
Family Nurse Practitioner
Primary
SP013788
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102982740
—
PA
Enumeration date
07/10/2006
Last updated
12/16/2019
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