Provider Demographics
NPI:1598819005
Name:PUUMALA, DIERRE N (FNP)
Entity Type:Individual
Prefix:
First Name:DIERRE
Middle Name:N
Last Name:PUUMALA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 124
Mailing Address - Street 2:
Mailing Address - City:GRAND LAKE
Mailing Address - State:CO
Mailing Address - Zip Code:80447-0124
Mailing Address - Country:US
Mailing Address - Phone:970-627-1788
Mailing Address - Fax:
Practice Address - Street 1:7455 W COLFAX AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-5400
Practice Address - Country:US
Practice Address - Phone:303-645-4892
Practice Address - Fax:303-232-3571
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO72301363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO53871774Medicaid
CO53871774Medicaid
CO807774Medicare Oscar/Certification
CO807774Medicare PIN