Provider Demographics
NPI:1063428845
Name:COSTELOW, MARSHA ANNE (ANP AND GNP)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:ANNE
Last Name:COSTELOW
Suffix:
Gender:F
Credentials:ANP AND GNP
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Mailing Address - Street 1:1055 CLERMONT STREET
Mailing Address - Street 2:MARSHA COSTELOW (11B) C/O DENVER VAMC/ECHCS
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220
Mailing Address - Country:US
Mailing Address - Phone:303-399-8020
Mailing Address - Fax:303-393-4670
Practice Address - Street 1:1055 CLERMONT STREET
Practice Address - Street 2:MARSHA COSTELOW (11B) C/O DENVER VAMC/ECHCS
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220
Practice Address - Country:US
Practice Address - Phone:303-399-8020
Practice Address - Fax:303-393-4670
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO72645363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
COVAD000Medicare UPIN