Provider Demographics
NPI:1790133973
Name:KOLTUN, TAMARA (ACUPUNCTURIST)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:
Last Name:KOLTUN
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7134 WEDDINGTON BROOK DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-7270
Mailing Address - Country:US
Mailing Address - Phone:704-849-7784
Mailing Address - Fax:
Practice Address - Street 1:7134 WEDDINGTON BROOK DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28104-7270
Practice Address - Country:US
Practice Address - Phone:704-849-7784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-29
Last Update Date:2016-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAC-808171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist