Provider Demographics
NPI:1578714572
Name:WHITE, DIANA JILL BUCKNER (PA-C)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:JILL BUCKNER
Last Name:WHITE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4700 HALE PKWY STE 520
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-4053
Mailing Address - Country:US
Mailing Address - Phone:303-388-1945
Mailing Address - Fax:303-388-1979
Practice Address - Street 1:4700 HALE PKWY STE 520
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-4053
Practice Address - Country:US
Practice Address - Phone:303-388-1945
Practice Address - Fax:303-388-1979
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2017-03-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO2705363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical