Provider Demographics
NPI:1609226778
Name:BANTA CORONA, DENA D (NP)
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:D
Last Name:BANTA CORONA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DENA
Other - Middle Name:D
Other - Last Name:BANTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:3289 F 1/4 RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:CO
Mailing Address - Zip Code:81520-7546
Mailing Address - Country:US
Mailing Address - Phone:970-640-8156
Mailing Address - Fax:
Practice Address - Street 1:3150 N 12TH ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-2863
Practice Address - Country:US
Practice Address - Phone:970-245-1220
Practice Address - Fax:970-245-9148
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0160888163W00000X
COAPN.0992451-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse