Provider Demographics
NPI:1750434247
Name:COSTELLO SHEA, MARGARET A (RN)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:A
Last Name:COSTELLO SHEA
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 1:5829 KARA PL
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3328
Mailing Address - Country:US
Mailing Address - Phone:703-582-5279
Mailing Address - Fax:757-961-6593
Practice Address - Street 1:MC DONALD ARMY HC, 576 JEFFERSON AVE
Practice Address - Street 2:CREDENTIALLY DEPT.
Practice Address - City:FORT EUSTIS
Practice Address - State:VA
Practice Address - Zip Code:23604-5548
Practice Address - Country:US
Practice Address - Phone:757-314-7522
Practice Address - Fax:757-314-7520
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0-001151322163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management