Provider Demographics
NPI:1598924052
Name:HESSELBROCK, DIANE REBECCA (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:REBECCA
Last Name:HESSELBROCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5770 FLINTRIDGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1870
Mailing Address - Country:US
Mailing Address - Phone:719-445-9902
Mailing Address - Fax:719-387-0312
Practice Address - Street 1:5818 N NEVADA AVE STE 225
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3547
Practice Address - Country:US
Practice Address - Phone:719-365-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00541102084N0400X
IAR-83332084N0400X
VA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO64920330Medicaid