Costello Gard, Libby A

Costello Gard, Libby A is an individual health care provider with primary practice located at 1211 S Reserve St Ste 101 , Missoula MT 59801-3103. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Ambulatory Care, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Costello Gard, Libby A can be contacted via phone (406) 327-3057.

Contact Information

Primary practice address
1211 S Reserve St Ste 101 Missoula MT 59801-3103
Phone: (406) 327-3057
Fax: (406) 327-3231
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Ambulatory Care 163WP2201X 099007632RN Oregon
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 200850014NP Oregon
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X NUR-APRN-LIC-126782 Montana

Profile Details

NPI number 1326239195
LBN Legal business name Costello Gard, Libby A
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 7th, 2007
Last updated May 10th, 2021 - about 3 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 1326239195 NPPES
Oregon MEDICAID 500616442

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