Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | F4306041 | NY |
NPI | 1023356227 |
---|---|
Provider Name | Julie Lyn Costello |
First Address | Mineola, NY 11501-3957 |
Second Address | Mineola, NY 11501-3957 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2013 |
Last Update Date | 05/12/2014 |