Provider Demographics
NPI:1174034680
Name:COSTELLO, KAREN R (ST)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:R
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:ST
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Mailing Address - Street 1:11704 W CENTER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4327
Mailing Address - Country:US
Mailing Address - Phone:402-691-0500
Mailing Address - Fax:402-691-1586
Practice Address - Street 1:11704 W CENTER RD STE 200
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4327
Practice Address - Country:US
Practice Address - Phone:402-691-0500
Practice Address - Fax:402-691-1586
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist