MEDICARE: RENA DIEM PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APN.0999400-NP	CO
2	367A00000X	Advanced Practice Midwife	RN0000172804	TN

General Provider Information

NPI Number	:	1730470055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENA DIEM PMHNP-BC

Provider Business Mailing Address
First Line	:	323 E 27TH ST
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-3203
Country	:	US
Telephone Number	:	970-310-3406
Fax Number	:	888-965-4615

Provider Business Practice Location Address
First Line	:	323 E 27TH ST
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-3203
Country	:	US
Telephone Number	:	970-310-3406
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2011
Last Update Date	:	03/06/2024

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