Provider Demographics
NPI:1841334588
Name:WALTERS, DIANA LOUISE (RN,EDD,MPH)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:LOUISE
Last Name:WALTERS
Suffix:
Gender:F
Credentials:RN,EDD,MPH
Other - Prefix:DR
Other - First Name:DIANA
Other - Middle Name:LOUISE
Other - Last Name:SAMMONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN EDD MPH
Mailing Address - Street 1:1400 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-3004
Mailing Address - Country:US
Mailing Address - Phone:970-241-1983
Mailing Address - Fax:970-242-6135
Practice Address - Street 1:1400 N 7TH ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-3004
Practice Address - Country:US
Practice Address - Phone:970-241-1983
Practice Address - Fax:970-242-6135
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO87831106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist