Provider Demographics
NPI:1396827291
Name:MCDONALD, DIANE GAIL (PAC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:GAIL
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:GAIL
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:PO BOX 17953
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4074
Mailing Address - Country:US
Mailing Address - Phone:303-991-7979
Mailing Address - Fax:303-991-7947
Practice Address - Street 1:695 S COLORADO BLVD STE 160
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246
Practice Address - Country:US
Practice Address - Phone:303-991-7979
Practice Address - Fax:303-999-1794
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2036363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COMM1171242OtherDEA