Healthcare Provider Details

I. General information

NPI: 1174149983
Provider Name (Legal Business Name): DIANA LYNN BAILEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4565 KENDALL PKWY
LOVELAND CO
80538-9268
US

IV. Provider business mailing address

3515 E OVERLAND RD
MERIDIAN ID
83642-6757
US

V. Phone/Fax

Practice location:
  • Phone: 970-410-8228
  • Fax:
Mailing address:
  • Phone: 208-605-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number000000
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0995709-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: