Healthcare Provider Details

I. General information

NPI: 1376360206
Provider Name (Legal Business Name): DIANNE MONTIEL PADALA RN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANNE MONTIEL

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14280 E JEWELL AVE STE B
AURORA CO
80012-7939
US

IV. Provider business mailing address

10210 COSMOPOLITAN CIR
PARKER CO
80134-3812
US

V. Phone/Fax

Practice location:
  • Phone: 303-214-3370
  • Fax:
Mailing address:
  • Phone: 765-277-4720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number1669562
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: