Individual provider · Type 1 NPI

Brianna Elizabeth-O'Mara Costello, PA-C

Medical Physician Assistant · Portland, OR

NPI number 1417594664 Active

Practice location

3303 S Bond Ave
Portland, OR 97239-4501

Fax (503) 494-3457

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant Primary 363AM0700XPA196976 (OR)

Medical Physician Assistant: Definition to come...

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About NPI 1417594664

Brianna Elizabeth-O'Mara Costello, PA-C's National Provider Identifier is 1417594664, issued on Dec 6, 2019. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Portland, OR. The record was last updated on Oct 4, 2021.