Individual
JON COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
4801 VETERANS DR, SAINT CLOUD, MN 56303-2015
(320) 252-1670
(320) 255-6312
Mailing address
1525 OXFORD LN, SAINT CLOUD, MN 56303-0317
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
678937
MN
Other
Enumeration date
09/25/2024
Last updated
09/25/2024
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