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General NPI Number Information
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NPI Number | 1568954022
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Entity Type | Individual
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Provider Name | MEGAN JILLIAN COSTELLO CRNP
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Gender | Female
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Dates
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Enumeration Date | 05/31/2018
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 155 WILSON AVE
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City | WASHINGTON
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State | PA
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Zip | 15301-3336
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Country | US
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Telephone | 724-223-3085
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Fax |
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Provider Business Mailing Address
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Address Line | 239 MOUNTAIN DR
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City | CARNEGIE
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State | PA
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Zip | 15106-2267
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Country | US
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Telephone | 724-255-9503
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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 | SP018898
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License Number State | PA
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