Provider Demographics
NPI:1023268414
Name:KOLTES, SVITLANA O (LPM)
Entity type:Individual
Prefix:
First Name:SVITLANA
Middle Name:O
Last Name:KOLTES
Suffix:
Gender:F
Credentials:LPM
Other - Prefix:
Other - First Name:SVITLANA
Other - Middle Name:O
Other - Last Name:KOLTES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6314 19TH ST.W., SUITE#7
Mailing Address - Street 2:
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466
Mailing Address - Country:US
Mailing Address - Phone:253-988-9717
Mailing Address - Fax:
Practice Address - Street 1:6314 19TH ST.W. SUITE#7
Practice Address - Street 2:
Practice Address - City:FIRCREST
Practice Address - State:WA
Practice Address - Zip Code:98466
Practice Address - Country:US
Practice Address - Phone:253-988-9717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA 00020371174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0199517OtherDEPARTMENT OF LABOR AND INDUSTRIES