Provider Demographics
NPI:1497468862
Name:COSTELLO, JAMES WILLIAM (MS, MBA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WILLIAM
Last Name:COSTELLO
Suffix:
Gender:M
Credentials:MS, MBA
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Other - Credentials:
Mailing Address - Street 1:PO BOX 400787
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89140-0787
Mailing Address - Country:US
Mailing Address - Phone:702-367-7777
Mailing Address - Fax:
Practice Address - Street 1:5145 S DURANGO DR STE 102
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-0161
Practice Address - Country:US
Practice Address - Phone:702-367-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-02
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No170300000XOther Service ProvidersGenetic Counselor, MS