Individual
MS. MARY JOAN COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Contact information
Practice address
1446 W MOORE AVE STE 206, TERRELL, TX 75160-2372
(972) 210-7350
Mailing address
1446 W MOORE AVE STE 206, TERRELL, TX 75160-2372
(972) 210-7350
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
AP140636
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1952563876
—
MO
05
—
ENROLLED
—
IL
Enumeration date
07/01/2008
Last updated
07/15/2025
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