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General NPI Number Information
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NPI Number | 1801951777
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Entity Type | Individual
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Provider Name | SUSAN COSTELLO ARNP
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Gender | Female
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 09/29/2016
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Provider Practice Location Address
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Address Line | 7070 SPRING ST
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City | OMAHA
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State | NE
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Zip | 68106-3519
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Country | US
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Telephone | 402-898-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 16929 FRANCES ST STE 103
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City | OMAHA
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State | NE
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Zip | 68130-4684
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Country | US
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Telephone | 402-717-4377
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 110734
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License Number State | NE
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