Provider Demographics
NPI:1154339315
Name:DIAMOND, LISA K (NP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 W US HIGHWAY 24
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-8968
Mailing Address - Country:US
Mailing Address - Phone:719-686-0878
Mailing Address - Fax:719-686-7331
Practice Address - Street 1:16420 W US HIGHWAY 24
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-8760
Practice Address - Country:US
Practice Address - Phone:719-687-9999
Practice Address - Fax:719-686-5725
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2481363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO49436236Medicaid
COCOA104234Medicare PIN
CO49436236Medicaid