Individual ProviderLaura N CostelloLicensed Practical NurseNursing Service ProvidersPractice Address29 Waterworks Rd, Patchogue, NY 11772-3214(631) 332-8479PECOS EnrollmentBased on the most recent information from CMS, provider Laura N Costello does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1437651510Provider TypeIndividualFull NameCostello, Laura NTitleMrs.CredentialLPNGenderFemaleSole ProprietorYesEnumeration Date3/5/2018Last Updated3/5/2018Contact InformationPractice LocationPractice Address29 Waterworks Rd, Patchogue, NY 11772-3214Phone(631) 332-8479FaxUnlisted FaxMailing LocationMailing Address29 Waterworks Rd, Patchogue, NY 11772-3214Phone(631) 332-8479FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode164W00000XPrimaryDescriptionLicensed Practical NurseNursing Service ProvidersLicense330845-1New York