MEDICARE: MS. SHERI DARLENE COSTELLIC CRNA

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
1	367500000X	Certified Registered Nurse Anesthetist	1145	CA

General Provider Information

NPI Number	:	1821069428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHERI DARLENE COSTELLIC CRNA

Provider Business Mailing Address
First Line	:	934 CAMINO DE LA REINA
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3240
Country	:	US
Telephone Number	:	619-688-3079
Fax Number	:

Provider Business Practice Location Address
First Line	:	NAVAL MEDICAL CENTER
Second Line	:	34800 BOB WILSONDR. SUITE409
City	:	SAN DIEGO
State	:	CA
Zip	:	92134-1409
Country	:	US
Telephone Number	:	619-532-9000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	07/08/2007

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