Provider Demographics
NPI:1114485679
Name:VANMARTER, DANA KIRBY (PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:KIRBY
Last Name:VANMARTER
Suffix:
Gender:F
Credentials:PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:CRESTED BUTTE
Mailing Address - State:CO
Mailing Address - Zip Code:81224-0151
Mailing Address - Country:US
Mailing Address - Phone:970-209-5952
Mailing Address - Fax:
Practice Address - Street 1:329 BELLEVIEW AVE
Practice Address - Street 2:STE C
Practice Address - City:CRESTED BUTTE
Practice Address - State:CO
Practice Address - Zip Code:81224
Practice Address - Country:US
Practice Address - Phone:970-209-5952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3199171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor