Provider Demographics
NPI:1669920484
Name:DIAZ, LYDIA (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:LYDIA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:
Other - Last Name:KREIGHBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6018 WOLF VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924-4206
Mailing Address - Country:US
Mailing Address - Phone:719-290-6892
Mailing Address - Fax:
Practice Address - Street 1:6018 WOLF VILLAGE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80924-4206
Practice Address - Country:US
Practice Address - Phone:719-290-6892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0992615-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner