Healthcare Provider Details

I. General information

NPI: 1184930927
Provider Name (Legal Business Name): LINDA DIANE MAGGIORE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 08/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 BLAKE AVE
GLENWOOD SPRINGS CO
81601-4229
US

IV. Provider business mailing address

195 W 14TH
RIFLE CO
81650-4700
US

V. Phone/Fax

Practice location:
  • Phone: 970-945-6614
  • Fax: 970-947-0155
Mailing address:
  • Phone: 970-625-5200
  • Fax: 970-625-4804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number40789
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: