Costello, Johnna Suzanne

Costello, Johnna Suzanne is an individual health care provider with primary practice located at 3311 E Murdock St , Wichita KS 67208-3054. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Costello, Johnna Suzanne can be contacted via phone (316) 689-9107.

Contact Information

Primary practice address
3311 E Murdock St Wichita KS 67208-3054
Phone: (316) 689-9107
Fax: (316) 689-9354
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 53-75854-011 Kansas

Profile Details

NPI number 1184968133
LBN Legal business name Costello, Johnna Suzanne
Credentials FNP-C
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 15th, 2012
Last updated Sep 30th, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184968133 NPPES
Kansas MEDICAID 201012490C
Kansas Other 003719478

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