Provider Demographics
NPI:1720876568
Name:COSTELLO, SHOWANA (LPN)
Entity type:Individual
Prefix:
First Name:SHOWANA
Middle Name:
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 1:1816 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-1720
Mailing Address - Country:US
Mailing Address - Phone:216-937-5672
Mailing Address - Fax:440-857-0693
Practice Address - Street 1:1816 NORTH AVE
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-1720
Practice Address - Country:US
Practice Address - Phone:216-937-5672
Practice Address - Fax:440-857-0693
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH186471164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse