Individual
CHRISTINA LEA COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
394 SINGLETON RIDGE RD, CONWAY, SC 29526-9150
(843) 347-8050
(843) 347-8049
Mailing address
300 SINGLETON RIDGE RD, ATTN CREDENTIALING, CONWAY, SC 29526-9142
(843) 234-6946
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
29621
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NN0900
—
SC
Enumeration date
11/06/2024
Last updated
02/14/2025
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