Provider Demographics
NPI:1104407568
Name:MOSTELLER, CORY KRISTEN (RN, LMT)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:KRISTEN
Last Name:MOSTELLER
Suffix:
Gender:F
Credentials:RN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15645 W BAKER AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-5541
Mailing Address - Country:US
Mailing Address - Phone:719-221-4910
Mailing Address - Fax:
Practice Address - Street 1:709 W LITTLETON BLVD
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-2365
Practice Address - Country:US
Practice Address - Phone:719-221-4910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-17
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.01980163W00000X
COMT.0023836225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No163W00000XNursing Service ProvidersRegistered Nurse