Provider Demographics
NPI:1770307563
Name:DIESI, ADAM (NP)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:DIESI
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19951 E RED FOX LN
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-3720
Mailing Address - Country:US
Mailing Address - Phone:303-763-0573
Mailing Address - Fax:
Practice Address - Street 1:2000 S BLACKHAWK ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1418
Practice Address - Country:US
Practice Address - Phone:303-763-0573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.1000313-NP207RA0401X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine