Provider Demographics
NPI:1356458855
Name:OSTERHN, TABITHA J (RN)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:J
Last Name:OSTERHN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TABITHA
Other - Middle Name:JO
Other - Last Name:MCINTYRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4505 SPRING CANON HTS
Mailing Address - Street 2:APT 203
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907
Mailing Address - Country:US
Mailing Address - Phone:608-449-4116
Mailing Address - Fax:
Practice Address - Street 1:3225 INTERNATIONAL CIRCLE
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910
Practice Address - Country:US
Practice Address - Phone:719-475-2229
Practice Address - Fax:719-475-2227
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO167291163W00000X
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse