Provider Demographics
NPI:1356470801
Name:COSTELLO, JOLENE THERESE (RN)
Entity Type:Individual
Prefix:MRS
First Name:JOLENE
Middle Name:THERESE
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 1:3333 E VEST AVE
Mailing Address - Street 2:
Mailing Address - City:HIGLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85236-5424
Mailing Address - Country:US
Mailing Address - Phone:480-279-7000
Mailing Address - Fax:
Practice Address - Street 1:2069 S DELATORRE DRIVE
Practice Address - Street 2:
Practice Address - City:HIGLEY
Practice Address - State:AZ
Practice Address - Zip Code:85236-5424
Practice Address - Country:US
Practice Address - Phone:480-279-7715
Practice Address - Fax:480-279-7705
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)