Provider Demographics
NPI:1952392540
Name:BREWER, DIANE M (CRNA)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:BREWER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 E MAPLEWOOD AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4727
Mailing Address - Country:US
Mailing Address - Phone:314-616-4730
Mailing Address - Fax:
Practice Address - Street 1:8000 E MAPLEWOOD AVE
Practice Address - Street 2:STE 200
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-4727
Practice Address - Country:US
Practice Address - Phone:303-438-3999
Practice Address - Fax:720-439-9500
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO188755163W00000X
MO2000151476367500000X
CO5918367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCRA-5918OtherCOLORADO NURSING BOARD
MO916251804Medicaid
CORN-188755OtherCOLORADO NURSING BOARD
MOP00281259OtherRR MEDICARE
CO96621231Medicaid
MO916251804Medicaid