Provider Demographics
NPI:1982203360
Name:COSTELLO, ALICE MARY (FNP)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:MARY
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10 S POINTE LNDG STE 250
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-3483
Mailing Address - Country:US
Mailing Address - Phone:585-426-4084
Mailing Address - Fax:585-426-4631
Practice Address - Street 1:10 S POINTE LNDG STE 250
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-3483
Practice Address - Country:US
Practice Address - Phone:585-426-4084
Practice Address - Fax:585-426-4631
Is Sole Proprietor?:No
Enumeration Date:2020-10-18
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY345596363LF0000X
NYF345596207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine