Provider Demographics
NPI:1932478054
Name:COSTELLO, BRYNN (RN)
Entity Type:Individual
Prefix:MS
First Name:BRYNN
Middle Name:
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 1:274 S PEARL ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12202-1829
Mailing Address - Country:US
Mailing Address - Phone:518-475-6657
Mailing Address - Fax:518-475-6658
Practice Address - Street 1:274 S PEARL ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12202-1829
Practice Address - Country:US
Practice Address - Phone:518-475-6657
Practice Address - Fax:518-475-6658
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22 552978163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse