Provider Demographics
NPI:1720292725
Name:SCRIVEN, DIANE L (FNP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:L
Last Name:SCRIVEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 DELMAR ST
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-4138
Mailing Address - Country:US
Mailing Address - Phone:970-522-6120
Mailing Address - Fax:970-522-7700
Practice Address - Street 1:108 DELMAR ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-4138
Practice Address - Country:US
Practice Address - Phone:970-522-6120
Practice Address - Fax:970-522-7700
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO54533363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
COS63911Medicare UPIN