Provider Demographics
NPI:1124096938
Name:COSTELLO, JOY L (LPN)
Entity type:Individual
Prefix:MRS
First Name:JOY
Middle Name:L
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17613 EASTON RD
Mailing Address - Street 2:
Mailing Address - City:SALESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43778-9878
Mailing Address - Country:US
Mailing Address - Phone:740-489-9248
Mailing Address - Fax:
Practice Address - Street 1:17347 PIPA RD
Practice Address - Street 2:
Practice Address - City:PLEASANT CITY
Practice Address - State:OH
Practice Address - Zip Code:43772-9668
Practice Address - Country:US
Practice Address - Phone:740-685-0854
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-111149164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2364436OtherPERSONAL PROVIDER NUMBER