Healthcare Provider Details

I. General information

NPI: 1063428845
Provider Name (Legal Business Name): MARSHA ANNE COSTELOW ANP AND GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 CLERMONT STREET MARSHA COSTELOW (11B) C/O DENVER VAMC/ECHCS
DENVER CO
80220
US

IV. Provider business mailing address

1055 CLERMONT STREET MARSHA COSTELOW (11B) C/O DENVER VAMC/ECHCS
DENVER CO
80220
US

V. Phone/Fax

Practice location:
  • Phone: 303-399-8020
  • Fax: 303-393-4670
Mailing address:
  • Phone: 303-399-8020
  • Fax: 303-393-4670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number72645
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: