Individual
ELIZABETH COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
4603 JOHN GARRY DR STE 10, COLUMBIA, MO 65203-6834
(573) 777-8783
(573) 777-8784
Mailing address
3705 BEDFORD DR, COLUMBIA, MO 65203-5367
(573) 449-4628
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2008020712
MO
Other
Enumeration date
03/23/2018
Last updated
03/23/2018
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