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General NPI Number Information
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NPI Number | 1154115459
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Entity Type | Individual
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Provider Name | CLARE COSTELLO FNP
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Gender |
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Dates
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Enumeration Date | 04/09/2025
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 9000 W WISCONSIN AVE
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City | MILWAUKEE
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State | WI
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Zip | 53226-4874
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Country | US
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Telephone | 414-266-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 9000 W WISCONSIN AVE
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City | MILWAUKEE
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State | WI
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Zip | 53226-4874
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | C-APN.0103118-C-NP
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License Number State | WI
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