Provider Demographics
NPI:1093905234
Name:KOSTMAN, TANYA G (MT)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:G
Last Name:KOSTMAN
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5156 PALOMA ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-5337
Mailing Address - Country:US
Mailing Address - Phone:303-594-2596
Mailing Address - Fax:303-655-0998
Practice Address - Street 1:1606 PRAIRIE CENTER PARKWAY
Practice Address - Street 2:SUITE 130
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601
Practice Address - Country:US
Practice Address - Phone:303-498-1840
Practice Address - Fax:303-498-1845
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist