Provider Demographics
NPI:1962574012
Name:COSTELLO, AIMEE GRACE (RN, MSN, CPNP)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:GRACE
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:RN, MSN, CPNP
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:606 SUISMON ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4927
Mailing Address - Country:US
Mailing Address - Phone:724-747-9470
Mailing Address - Fax:
Practice Address - Street 1:4401 PENN AVE
Practice Address - Street 2:HEM/ONC 8TH FLOOR FP
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1334
Practice Address - Country:US
Practice Address - Phone:412-692-6506
Practice Address - Fax:412-692-6675
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP008766363LP0200X
PARN534482363LP0200X
PAMK1336658363LP0200X
PA004398363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics