Provider Demographics
NPI:1326098674
Name:NOGA, DIANE D (CASE MANAGER)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:D
Last Name:NOGA
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 PENNSYLVANIA AVE
Mailing Address - Street 2:PO BOX 532
Mailing Address - City:WALSENBURG
Mailing Address - State:CO
Mailing Address - Zip Code:81089
Mailing Address - Country:US
Mailing Address - Phone:719-738-1477
Mailing Address - Fax:
Practice Address - Street 1:220 4TH AVENUE
Practice Address - Street 2:
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740
Practice Address - Country:US
Practice Address - Phone:505-445-2754
Practice Address - Fax:505-445-2225
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist