Provider Demographics
NPI:1518432517
Name:DICE, ALLI RENEE
Entity Type:Individual
Prefix:
First Name:ALLI
Middle Name:RENEE
Last Name:DICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALLI
Other - Middle Name:RENEE
Other - Last Name:DAEMKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:5745 E OLD FARM CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-1141
Mailing Address - Country:US
Mailing Address - Phone:719-963-2733
Mailing Address - Fax:
Practice Address - Street 1:115 S PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3130
Practice Address - Country:US
Practice Address - Phone:719-266-3530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1655556163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse