Provider Demographics
NPI:1245566629
Name:COSTELLO, MARGARET IRENE (RN, ARNP)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:IRENE
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:RN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7617 MAPLE
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-4749
Mailing Address - Country:US
Mailing Address - Phone:913-953-9291
Mailing Address - Fax:
Practice Address - Street 1:6420 PROSPECT AVE
Practice Address - Street 2:SUITE T407
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-4147
Practice Address - Country:US
Practice Address - Phone:816-333-5424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-87361-081163W00000X
MO2009032629363LA2200X
MO2009026203163W00000X
KS53-74998-081363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse