Provider Demographics
NPI:1184223513
Name:COSTLOW, RYAN MATTHEW (NP)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:MATTHEW
Last Name:COSTLOW
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:MATTHEW
Other - Last Name:COSTLOW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:5605 MADRID DR
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-4136
Mailing Address - Country:US
Mailing Address - Phone:330-518-2902
Mailing Address - Fax:
Practice Address - Street 1:5605 MADRID DR
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-4136
Practice Address - Country:US
Practice Address - Phone:330-518-2902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0026869363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner