Provider Demographics
NPI:1649698051
Name:STEMMERMAN, TANYA LEA (NCTMB)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:LEA
Last Name:STEMMERMAN
Suffix:
Gender:F
Credentials:NCTMB
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:LEA
Other - Last Name:PRATKELIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NCTMB
Mailing Address - Street 1:14350 OSAGE ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80023-8443
Mailing Address - Country:US
Mailing Address - Phone:303-941-7604
Mailing Address - Fax:
Practice Address - Street 1:14350 OSAGE ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80023-8443
Practice Address - Country:US
Practice Address - Phone:303-941-7604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4872174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist