Provider Demographics
NPI:1710421193
Name:COSTALEZ, JUDY ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:ANN
Last Name:COSTALEZ
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 1:620 S MCKINLEY ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-3414
Mailing Address - Country:US
Mailing Address - Phone:307-337-5351
Mailing Address - Fax:
Practice Address - Street 1:620 S MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-3414
Practice Address - Country:US
Practice Address - Phone:307-337-5351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management