Provider Demographics
NPI:1275672461
Name:BARNES, DIANE (NP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:BARNES
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 1:1055 CLERMONT ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3808
Mailing Address - Country:US
Mailing Address - Phone:303-399-8020
Mailing Address - Fax:303-370-7527
Practice Address - Street 1:11005 RALSTON RD
Practice Address - Street 2:SUITE 100 - G
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-4551
Practice Address - Country:US
Practice Address - Phone:303-431-0844
Practice Address - Fax:303-456-6124
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO88784363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO40637565Medicaid