Healthcare Provider Details

I. General information

NPI: 1316897614
Provider Name (Legal Business Name): DIANA PHILLIPS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2026
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 MOUNTAIN VIEW AVE STE 540
LONGMONT CO
80501-3183
US

IV. Provider business mailing address

676 MCGEAL PL
LAFAYETTE CO
80026-1168
US

V. Phone/Fax

Practice location:
  • Phone: 303-651-5252
  • Fax:
Mailing address:
  • Phone: 303-651-5252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number1646732
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: