Individual
CATHY COSTLOW MCDONALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
1400A E 20TH ST, EXCEPTIONAL PROGRAMS OFFICE, FARMINGTON, NM 87401-9024
(505) 599-8762
(505) 599-8796
Mailing address
1400A E 20TH ST, EXCEPTIONAL PROGRAMS OFFICE, FARMINGTON, NM 87401-9024
(505) 599-8762
(505) 599-8796
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
R2190
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R25190
RN LICENSE
NM
Enumeration date
10/12/2016
Last updated
10/13/2016
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