Provider Demographics
NPI:1750625638
Name:WOSTENBERG, ALLISON KATHLEEN (APRN, ANP-BC)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:KATHLEEN
Last Name:WOSTENBERG
Suffix:
Gender:F
Credentials:APRN, ANP-BC
Other - Prefix:MS
Other - First Name:ALLISON
Other - Middle Name:KATHLEEN
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, ANP-BC
Mailing Address - Street 1:1700 N WHEELING ST
Mailing Address - Street 2:RMR VA MEDICAL CENTER (F2-111A)
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045
Mailing Address - Country:US
Mailing Address - Phone:720-723-6091
Mailing Address - Fax:720-723-7884
Practice Address - Street 1:1700 N WHEELING ST
Practice Address - Street 2:RMR VA MEDICAL CENTER (F2-111A)
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045
Practice Address - Country:US
Practice Address - Phone:720-723-6091
Practice Address - Fax:720-723-7884
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0993834-NP363LA2200X
KY3007753363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health