Provider Demographics
NPI:1710963962
Name:HORNUNG, DIANA (MD)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:
Last Name:HORNUNG
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 1:745 RUSSELL ST.
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:CO
Mailing Address - Zip Code:81625-2019
Mailing Address - Country:US
Mailing Address - Phone:970-824-8233
Mailing Address - Fax:970-824-2548
Practice Address - Street 1:745 RUSSELL ST.
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625-2019
Practice Address - Country:US
Practice Address - Phone:970-824-8233
Practice Address - Fax:970-824-2548
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42145207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO56434375Medicaid
CO803272Medicare PIN
CO56434375Medicaid