Provider Demographics
NPI:1063912848
Name:DIPRIMO, MICHAEL SHANNON (ARNP)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:SHANNON
Last Name:DIPRIMO
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
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Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:719-538-2900
Mailing Address - Fax:719-538-2990
Practice Address - Street 1:1707 COLE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-3219
Practice Address - Country:US
Practice Address - Phone:303-763-4900
Practice Address - Fax:303-763-5495
Is Sole Proprietor?:No
Enumeration Date:2018-02-18
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9274858363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9274858OtherSTATE