Provider Demographics
NPI:1235641994
Name:COSTELLO, SHARON CLAIR (RN)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:CLAIR
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 EAST ST
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:ME
Mailing Address - Zip Code:04901-3309
Mailing Address - Country:US
Mailing Address - Phone:207-453-4708
Mailing Address - Fax:207-453-6250
Practice Address - Street 1:11 EAST ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:ME
Practice Address - Zip Code:04901-3309
Practice Address - Country:US
Practice Address - Phone:207-453-4708
Practice Address - Fax:207-453-6250
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN38869163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME010491217OtherMAINE