Healthcare Provider Details

I. General information

NPI: 1316695059
Provider Name (Legal Business Name): DIANA SUE PACHECO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2022
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 S DELAWARE ST
ENGLEWOOD CO
80110-3529
US

IV. Provider business mailing address

7495 W 29TH AVE
WHEAT RIDGE CO
80033-8002
US

V. Phone/Fax

Practice location:
  • Phone: 303-360-6276
  • Fax:
Mailing address:
  • Phone: 303-360-6276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0997423-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: