Provider Demographics
NPI:1558752089
Name:KOSHAK, DIANNE CATHERINE (RN)
Entity Type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:CATHERINE
Last Name:KOSHAK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:925 6TH ST
Mailing Address - Street 2:ROOM 101
Mailing Address - City:DEL NORTE
Mailing Address - State:CO
Mailing Address - Zip Code:81132-9796
Mailing Address - Country:US
Mailing Address - Phone:719-657-3352
Mailing Address - Fax:719-657-2286
Practice Address - Street 1:925 6TH ST
Practice Address - Street 2:ROOM 101
Practice Address - City:DEL NORTE
Practice Address - State:CO
Practice Address - Zip Code:81132-9796
Practice Address - Country:US
Practice Address - Phone:719-657-3352
Practice Address - Fax:719-657-2286
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN0171424163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse