Provider Demographics
NPI:1295376416
Name:DIETZ, JEANNA LEE (NP)
Entity type:Individual
Prefix:
First Name:JEANNA
Middle Name:LEE
Last Name:DIETZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5340 S QUEBEC ST STE 225N
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1934
Mailing Address - Country:US
Mailing Address - Phone:720-734-4411
Mailing Address - Fax:
Practice Address - Street 1:5340 S QUEBEC ST STE 225N
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-1934
Practice Address - Country:US
Practice Address - Phone:720-734-4411
Practice Address - Fax:720-204-7497
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0995067-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health