Provider Demographics
NPI:1346720877
Name:COSTELLO, DONNA (LPN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BAXTER DR STE 170
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-7632
Mailing Address - Country:US
Mailing Address - Phone:540-908-3917
Mailing Address - Fax:
Practice Address - Street 1:30 BAXTER DR STE 170
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-7632
Practice Address - Country:US
Practice Address - Phone:540-908-3917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002038235164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse