Individual
MRS. JILLIAN MARIE COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
111 S 11TH ST, PHILADELPHIA, PA 19107-4824
(215) 955-6000
Mailing address
401 S ISEMINGER ST, PHILADELPHIA, PA 19147-1113
(609) 560-0541
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
SP023213
PA
Other
Enumeration date
02/06/2021
Last updated
02/06/2021
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