Healthcare Provider Details

I. General information

NPI: 1659795607
Provider Name (Legal Business Name): ADRIANA MARIA DIVO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2014
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 CASTLE CREEK RD
ASPEN CO
81611-1159
US

IV. Provider business mailing address

401 CASTLE CREEK RD
ASPEN CO
81611-1159
US

V. Phone/Fax

Practice location:
  • Phone: 970-925-1120
  • Fax: 949-588-2199
Mailing address:
  • Phone: 970-925-1120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11013796
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN.0993080-CRNA
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: