Provider Demographics
NPI:1073135794
Name:HOSTETLER, DENISE (CNIM)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:HOSTETLER
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:
Other - Last Name:NAVARRO-HOSTETLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1945
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80901-1945
Mailing Address - Country:US
Mailing Address - Phone:720-799-1422
Mailing Address - Fax:719-487-2689
Practice Address - Street 1:1861 CASTLEWOOD DR
Practice Address - Street 2:
Practice Address - City:FRANKTOWN
Practice Address - State:CO
Practice Address - Zip Code:80116-9009
Practice Address - Country:US
Practice Address - Phone:303-946-6212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4432246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty