Provider Demographics
NPI:1912593385
Name:JOSEPH-OMWANGHE, DIEUNETTE (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:DIEUNETTE
Middle Name:
Last Name:JOSEPH-OMWANGHE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4161 S FRASER CT APT F
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-4180
Mailing Address - Country:US
Mailing Address - Phone:706-403-7327
Mailing Address - Fax:
Practice Address - Street 1:430 INDIANA ST STE 100
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-5012
Practice Address - Country:US
Practice Address - Phone:303-736-9697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-18
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0996191-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty