Provider Demographics
NPI:1013105857
Name:ANDERSON, DIANE KAY (RN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:KAY
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:589 VIRGINIA CANYON ROAD
Mailing Address - Street 2:PO BOX 322
Mailing Address - City:CENTRAL CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80427-0322
Mailing Address - Country:US
Mailing Address - Phone:303-582-5492
Mailing Address - Fax:
Practice Address - Street 1:2500 S HAVANA ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1618
Practice Address - Country:US
Practice Address - Phone:303-332-2274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42865163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse