Provider Demographics
NPI:1790324200
Name:CASTELLOW, INDIA N (RN,BSN)
Entity Type:Individual
Prefix:MRS
First Name:INDIA
Middle Name:N
Last Name:CASTELLOW
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 BAY BREEZE DR
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3273
Mailing Address - Country:US
Mailing Address - Phone:757-778-3400
Mailing Address - Fax:
Practice Address - Street 1:1041 BAY BREEZE DR
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3273
Practice Address - Country:US
Practice Address - Phone:757-778-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAA60646650343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)