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General NPI Number Information
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NPI Number | 1417085846
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Entity Type | Individual
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Provider Name | CAROLYN S COSTELLA MSN APRN BC
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Gender | Female
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 1010 KINGS HWY S STE 2101
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City | CHERRY HILL
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State | NJ
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Zip | 08034-2524
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Country | US
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Telephone | 856-208-7300
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Fax | 856-254-0019
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Provider Business Mailing Address
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Address Line | 1010 KINGS HWY S STE 2101
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City | CHERRY HILL
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State | NJ
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Zip | 08034-2524
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Country | US
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Telephone | 856-208-7300
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Fax | 856-254-0019
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 26NJ00041700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 26NJ00041700
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 26NR10857800
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License Number State | NJ
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