Type 1 individualNPI 1003394479
MALISSA ANN COSTANZO OWNER
320900000X · FOREST LAKE, MN
Why this profile is appearing now
Observed change signals
No current public change signal is attached to this profile.
Reported classification
Taxonomies
| Code | Description | Source flag |
|---|---|---|
| 320900000X | 320900000X | Primary |
| 253J00000X | 253J00000X | Additional |
Taxonomy reporting does not establish licensure, board certification, expertise, or quality.
Longitudinal record
Observed change timeline
- 0 recorded field change s