Provider Demographics
NPI:1942389119
Name:KOLOSKI, DEIRDRE (LAC, ND)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:
Last Name:KOLOSKI
Suffix:
Gender:F
Credentials:LAC, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-4847
Mailing Address - Country:US
Mailing Address - Phone:970-667-7071
Mailing Address - Fax:
Practice Address - Street 1:1136 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-4847
Practice Address - Country:US
Practice Address - Phone:970-667-7071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO882171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist