Healthcare Provider Details

I. General information

NPI: 1497761613
Provider Name (Legal Business Name): VICKI LYNNE COSTELLO-ALHEIT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 BATTLEFIELD BLVD N
CHESAPEAKE VA
23320-4941
US

IV. Provider business mailing address

1129 SMOKEY MOUNTAIN TRL
CHESAPEAKE VA
23320-8149
US

V. Phone/Fax

Practice location:
  • Phone: 757-312-6678
  • Fax:
Mailing address:
  • Phone: 757-436-7448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0001090540
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: