Provider Demographics
NPI:1801858246
Name:MARKVA, DIANE M (AU D)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:MARKVA
Suffix:
Gender:F
Credentials:AU D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 S CAMINO DEL RIO STE 200B
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-6824
Mailing Address - Country:US
Mailing Address - Phone:970-272-0808
Mailing Address - Fax:970-238-2630
Practice Address - Street 1:1165 S CAMINO DEL RIO STE 200B
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-6824
Practice Address - Country:US
Practice Address - Phone:970-247-0808
Practice Address - Fax:970-238-2630
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMAUD22007237600000X
COAUD.0000952237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9451277Medicaid
VA9451277Medicaid
VA640000086Medicare ID - Type Unspecified