Individual
MRS. ERICA LEIGH COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5840 E 2ND ST STE 200, CASPER, WY 82609-4363
(307) 316-6133
(307) 315-6134
Mailing address
5840 E 2ND ST STE 200, CASPER, WY 82609-4363
(307) 315-6133
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
55430
CA
363AM0700X
Medical Physician Assistant
Primary
PA853
WY
Other
Enumeration date
04/06/2018
Last updated
10/26/2022
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