MEDICARE: ASHLEY DIANNE DEGRUSH FNP-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	363LF0000X	Family Nurse Practitioner	0991940	CO

General Provider Information

NPI Number	:	1912371964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY DIANNE DEGRUSH FNP-BC

Provider Business Mailing Address
First Line	:	7173 S HAVANA ST STE 100-81
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80112-3891
Country	:	US
Telephone Number	:	303-718-6899
Fax Number	:	303-374-2518

Provider Business Practice Location Address
First Line	:	7173 S HAVANA ST STE 100-81
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80112-3891
Country	:	US
Telephone Number	:	303-718-6899
Fax Number	:	303-374-2518

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

Provider Enumeration Date	:	11/13/2015
Last Update Date	:	09/03/2025

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