Basic Information
| Provider Information | |||||||||
| NPI: | 1063428845 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COSTELOW | ||||||||
| FirstName: | MARSHA | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | ANP AND GNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1055 CLERMONT STREET | ||||||||
| Address2: | MARSHA COSTELOW (11B) C/O DENVER VAMC/ECHCS | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033998020 | ||||||||
| FaxNumber: | 3033934670 | ||||||||
| Practice Location | |||||||||
| Address1: | 1055 CLERMONT STREET | ||||||||
| Address2: | MARSHA COSTELOW (11B) C/O DENVER VAMC/ECHCS | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033998020 | ||||||||
| FaxNumber: | 3033934670 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 72645 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.