Healthcare Provider Details

I. General information

NPI: 1598924052
Provider Name (Legal Business Name): DIANE REBECCA HESSELBROCK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5818 N NEVADA AVE STE 225
COLORADO SPRINGS CO
80918-3547
US

IV. Provider business mailing address

5770 FLINTRIDGE DR STE 100
COLORADO SPRINGS CO
80918-1870
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-6300
  • Fax:
Mailing address:
  • Phone: 719-445-9902
  • Fax: 719-387-0312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberDR.0054110
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberR-8333
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: