Provider Demographics
NPI:1558534123
Name:HEINZ, DIANA J (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:J
Last Name:HEINZ
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:J
Other - Last Name:HEINZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP-C
Mailing Address - Street 1:4863 N NEVADA AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3951
Mailing Address - Country:US
Mailing Address - Phone:719-526-7268
Mailing Address - Fax:719-526-7891
Practice Address - Street 1:1650 COCHRANE CIR
Practice Address - Street 2:
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4613
Practice Address - Country:US
Practice Address - Phone:719-526-7268
Practice Address - Fax:719-526-7891
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-03
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO124663363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily