Provider Demographics
NPI:1073116125
Name:CHANG, DIEM NGUYEN (NP)
Entity Type:Individual
Prefix:
First Name:DIEM
Middle Name:NGUYEN
Last Name:CHANG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 WEWATTA ST APT 20619
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-6381
Mailing Address - Country:US
Mailing Address - Phone:704-806-2625
Mailing Address - Fax:
Practice Address - Street 1:9195 GRANT ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4385
Practice Address - Country:US
Practice Address - Phone:720-647-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1667433163W00000X
COAPN.0995908363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse