Healthcare Provider Details

I. General information

NPI: 1710608476
Provider Name (Legal Business Name): DIANA DAMAWAND BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1056 BLACK SADDLE ST
ELIZABETH CO
80107-8518
US

IV. Provider business mailing address

1056 BLACK SADDLE ST
ELIZABETH CO
80107-8518
US

V. Phone/Fax

Practice location:
  • Phone: 720-626-1148
  • Fax:
Mailing address:
  • Phone: 172-062-6114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.1639724
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: