Healthcare Provider Details

I. General information

NPI: 1134112857
Provider Name (Legal Business Name): JANET BRAIDWOOD COSTELLO MS, CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1847 W PLAZA DR APPLE BLOSSOM FAMILY PRACTICE
WINCHESTER VA
22601-6365
US

IV. Provider business mailing address

327 DRUID HL
FRONT ROYAL VA
22630-2413
US

V. Phone/Fax

Practice location:
  • Phone: 540-678-0792
  • Fax:
Mailing address:
  • Phone: 540-635-2300
  • Fax: 540-678-0795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024087875
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0001087875
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0017001440
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: