Provider Demographics
NPI:1821362476
Name:COSTLOW, JANE A (CRNA)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:A
Last Name:COSTLOW
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WINDBER
Mailing Address - State:PA
Mailing Address - Zip Code:15963-1344
Mailing Address - Country:US
Mailing Address - Phone:814-467-4578
Mailing Address - Fax:
Practice Address - Street 1:401 7TH ST
Practice Address - Street 2:
Practice Address - City:WINDBER
Practice Address - State:PA
Practice Address - Zip Code:15963-1344
Practice Address - Country:US
Practice Address - Phone:814-467-4578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA89292367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered