Provider Demographics
NPI:1720262652
Name:KAUFMAN, DIANA L (APN)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:L
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2839 CARLISLE BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-2876
Mailing Address - Country:US
Mailing Address - Phone:505-226-0001
Mailing Address - Fax:855-618-2297
Practice Address - Street 1:2839 CARLISLE BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-2876
Practice Address - Country:US
Practice Address - Phone:505-226-0001
Practice Address - Fax:855-618-2297
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209006925363LF0000X
NMCNP-03374363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM20108753Medicaid
ILK51369Medicare PIN
IL209006925Medicaid