REBEKAH COSTELLO (NPI# 1326452921) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326452921 |
| Entity Type | Individual |
| Full Name | REBEKAH COSTELLO |
| Credential | DO |
| Practice Address |
3400 Market Ln Kenosha WI 53144-3430 |
| Practice Telephone | 2625514600 |
| Practice Fax Number | 2625514630 |
| Mailing Telephone | 2625514600 |
| Mailing Fax Number | 2626535850 |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2019-07-01 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 71089-21 | WI | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | 036.144957 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 1326452921 | 05 | |
| IL | ILLINOIS MEDICAL LICENSE | 036.144957 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1000 Oakland Dr, Kalamazoo, MI 490081282 | 2693374400 | |
| 110 S 17th St, St Charles, IL 601742526 | 6303772800 |
| Street Address |
3400 MARKET LN |
| City | KENOSHA |
| State | WI |
| Zip Code | 53144-3430 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154377091 | Keven R Mottinger | Physician Assistant | 3400 Market Ln, Kenosha, WI 53144-3430 | 2006-05-25 |
| 1083261226 | Amanda Quinonez | Nurse Practitioner | 3400 Market Ln, Kenosha, WI 53144-3430 | 2019-08-22 |
| 1629534813 | Heather Nicole Thomas | Registered Nurse | 3400 Market Ln, Kenosha, WI 53144-3430 | 2019-02-13 |
| 1922573625 | Tarren Prange | Nurse Practitioner | 3400 Market Ln, Kenosha, WI 53144-3430 | 2018-10-09 |
| 1891260543 | Stephanie M Brown | Nurse Practitioner | 3400 Market Ln, Kenosha, WI 53144-3430 | 2018-10-09 |
| 1790297331 | Juli Marie Degrave | Nurse Practitioner | 3400 Market Ln, Kenosha, WI 53144-3430 | 2017-11-03 |
| 1750800884 | Christos Reppas | Physician Assistant | 3400 Market Ln, Kenosha, WI 53144-3430 | 2017-09-09 |
| 1417497710 | Shelley Flasch | Nurse Practitioner | 3400 Market Ln, Kenosha, WI 53144-3430 | 2017-03-06 |
| 1194193813 | Sandra Homan | Nurse Practitioner | 3400 Market Ln, Kenosha, WI 53144-3430 | 2015-09-11 |
| 1710306725 | Christine T Adique | Nurse Practitioner | 3400 Market Ln, Kenosha, WI 53144-3430 | 2014-04-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902410202 | Dpt Holdings LLC | Occupational Therapist | 3825 39th Ave #110, Kenosha, WI 53144 | 2020-09-03 |
| 1225641392 | Eunice Boatin | Social Worker | Kenosha Human Development Services, 3536 52nd Street, Kenosha, WI 53144 | 2020-08-28 |
| 1881250256 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 3621 Market Lane, Kenosha, WI 53144 | 2019-05-11 |
| 1124540067 | Kaitlyn King | Speech-Language Pathologist | 5219 88th Ave., Kenosha, WI 53144 | 2017-07-12 |
| 1174992721 | Claire Ann Adams | Acupuncturist | 5416 52nd Street, Kenosha, WI 53144 | 2015-09-24 |
| 1285017087 | Jessica Lynn Gillengerten | Acupuncturist | 4235 Green Bay Rd., Suite #10, Kenosha, WI 53144 | 2015-06-30 |
| 1750704656 | Amanda Kay Kreuzer | Occupational Therapy Assistant | 3109 30th Ave, Kenosha, WI 53144 | 2014-01-28 |
| 1841626785 | B7 Pharmacy Inc | Pharmacy | 3825 39th Ave Ste 100, Kenosha, WI 53144 | 2013-09-24 |
| 1124326764 | Wisconsin Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 3710 57th Ave, Kenosha, WI 53144 | 2011-03-07 |
| 1982931291 | Roman Bilak | General Practice | 4126 - 7th Street, Kemosha, WI 53144 | 2009-11-06 |
| Find all providers in zip 53144 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275003394 | Kimberly Shaffner | Family Medicine | 4536 22nd Avenue, Kenosha, WI 53140 | 2018-12-01 |
| 1770789489 | Kenosha Community Health Center, Inc | Family Medicine | 6226 14th Ave, Kenosha, WI 53143 | 2007-06-21 |
| 1578611703 | Anita I. Inveiss, M.d., S.c. | Family Medicine | 3618 8th Ave, Suite 12, Kenosha, WI 53140-2576 | 2007-01-05 |
| 1568523389 | Timothy Michael Hubbard | Family Medicine | 4400 Sheridan Rd, Kenosha, WI 53140-5747 | 2006-12-13 |
| 1417018656 | Alan Bart Cameron Sr. | Family Medicine | 5012 4th Ave, Kenosha, WI 53140-2902 | 2006-12-12 |
| 1477660744 | James M Santarelli | Family Medicine | 2707 15th Pl, Kenosha, WI 53140-4947 | 2006-08-24 |
| 1689620072 | Leonardo Montemurro Sr. | Family Medicine | 6121 Green Bay Rd Ste 100, Kenosha, WI 53142-2931 | 2006-05-26 |
| 1386608677 | Stephen P Feuerbach | Family Medicine | 5923 Green Bay Rd, Kenosha, WI 53144-3737 | 2006-04-13 |
| 1306833686 | Abdul Ghaffar Durrani | Family Medicine | 4824 Green Bay Road, Kenosha, WI 53144-1789 | 2005-10-03 |
| 1386631661 | Jawaid Quddus | Family Medicine | 6123 Green Bay Road, Suite 120, Kenosha, WI 53142-2927 | 2005-10-03 |
| Find all providers in KENOSHA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.