Provider Demographics
NPI:1114773470
Name:COLTEN-STEVENS, TAMARA (RN, BSN)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:COLTEN-STEVENS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 MARSHALL NEWLAND RD
Mailing Address - Street 2:
Mailing Address - City:EAST BURKE
Mailing Address - State:VT
Mailing Address - Zip Code:05832-9663
Mailing Address - Country:US
Mailing Address - Phone:802-745-7570
Mailing Address - Fax:
Practice Address - Street 1:149 MARSHALL NEWLAND RD
Practice Address - Street 2:
Practice Address - City:EAST BURKE
Practice Address - State:VT
Practice Address - Zip Code:05832-9663
Practice Address - Country:US
Practice Address - Phone:802-745-7570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-27
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT026.0112585163WG0000X
VI13518163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice