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NPI Code Detail

MEDICARE: BRENDA LEE COSTELLO-WELLS CNS APRN

MEDICARE: BRENDA LEE COSTELLO-WELLS CNS APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1364SP0807XChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist70000059AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447258314
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENDA LEE COSTELLO-WELLS CNS APRN
Provider Business Mailing Address
First Line : 6626 E 75TH STREET
Second Line : STE 500
City : INDIANAPOLIS
State : IN
Zip : 46250-2890
Country : US
Telephone Number : 317-621-7561
Fax Number : 317-355-6096
Provider Business Practice Location Address
First Line : 1500 N RITTER AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46219-3027
Country : US
Telephone Number : 317-355-2560
Fax Number : 317-355-2418
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2005
Last Update Date : 11/27/2023

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