Healthcare Provider Details

I. General information

NPI: 1821362476
Provider Name (Legal Business Name): JANE A COSTLOW CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 7TH ST
WINDBER PA
15963-1344
US

IV. Provider business mailing address

401 7TH ST
WINDBER PA
15963-1344
US

V. Phone/Fax

Practice location:
  • Phone: 814-467-4578
  • Fax:
Mailing address:
  • Phone: 814-467-4578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number89292
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: