Doctor Name: | CARLA C COSTELLO |
NPI Number: | 1356657746 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | RN095103 AP06260 |
Business Practice Address: | 320 N Hood St Lake Providence, LA - 712542140 |
Business Phone Number: | 3185592404 |
Business Fax Number: | |
Mailing Address: | 307 Mcgaha Rd, OAK GROVE |
State: | LA |
Postal Code: | 712636919 |
Phone Number: | 3185592404 |
Fax Number: | |
NPI Enumeration Date: | 08/24/2010 |
NPI Last Update Date: | 08/24/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | RN095103 AP06260 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |