Provider Demographics
NPI:1912612169
Name:LIEDTKA-HOLMQUIST, DIANA ELIZABETH (DNP)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:ELIZABETH
Last Name:LIEDTKA-HOLMQUIST
Suffix:
Gender:
Credentials:DNP
Other - Prefix:MRS
Other - First Name:DIANA
Other - Middle Name:ELIZABETH
Other - Last Name:LIEDTKA-HOLMQUIST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNP
Mailing Address - Street 1:2126 DIXON AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-8226
Mailing Address - Country:US
Mailing Address - Phone:406-241-6069
Mailing Address - Fax:406-926-4099
Practice Address - Street 1:2126 DIXON AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-8226
Practice Address - Country:US
Practice Address - Phone:406-241-6069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-20
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-242748363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily