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Individual

KELLY L COSTELLO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RD

Contact information

Practice address
2450 RIVERSIDE AVE, MINNEAPOLIS, MN 55454-1450
(612) 273-0069
Mailing address
6041 4TH AVE S, MINNEAPOLIS, MN 55419-2510
(612) 910-9579

Taxonomy

Speciality
Code
Description
License number
State
133VN1004X
Pediatric Nutrition Registered Dietitian
Primary
1690
MN

Other

Enumeration date
08/28/2007
Last updated
11/30/2012
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