Provider Demographics
NPI:1972865012
Name:BOZNER, DIANA CRYSTLE
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:CRYSTLE
Last Name:BOZNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-5610
Mailing Address - Country:US
Mailing Address - Phone:307-352-6677
Mailing Address - Fax:307-352-6614
Practice Address - Street 1:2300 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5610
Practice Address - Country:US
Practice Address - Phone:307-352-6677
Practice Address - Fax:307-352-6614
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator