Provider Demographics
NPI:1285884320
Name:EDIGER, DIANA JANE (NP)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:JANE
Last Name:EDIGER
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 1:2165 HOLLOW BROOK DR STE 10A
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1463
Mailing Address - Country:US
Mailing Address - Phone:719-332-0070
Mailing Address - Fax:719-434-3639
Practice Address - Street 1:2165 HOLLOW BROOK DR STE 10A
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1463
Practice Address - Country:US
Practice Address - Phone:719-332-0070
Practice Address - Fax:719-434-3639
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO116123163W00000X
CONP-5758363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO5758OtherCOLORADO BOARD OF NURSING
CO116123OtherSTATE OF COLORADO
COCO301660Medicare PIN