Provider Demographics
NPI:1063957272
Name:COSTELLO, COURTNEY EATON (RDN, LD)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:EATON
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:LOUISE
Other - Last Name:EATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, LD
Mailing Address - Street 1:199 STATE ROUTE 101 UNIT 653
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NH
Mailing Address - Zip Code:03031-8056
Mailing Address - Country:US
Mailing Address - Phone:603-391-8206
Mailing Address - Fax:888-974-8589
Practice Address - Street 1:199 STATE ROUTE 101 UNIT 653
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NH
Practice Address - Zip Code:03031-8056
Practice Address - Country:US
Practice Address - Phone:603-391-8206
Practice Address - Fax:888-974-8589
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-23
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0844133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered