Provider Demographics
NPI:1134398555
Name:GILMORE, DIANNA LEE (LPN,CAC III)
Entity type:Individual
Prefix:
First Name:DIANNA
Middle Name:LEE
Last Name:GILMORE
Suffix:
Gender:F
Credentials:LPN,CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14201 E 4TH AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-8748
Mailing Address - Country:US
Mailing Address - Phone:303-326-0900
Mailing Address - Fax:303-326-0006
Practice Address - Street 1:14201 E 4TH AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-8748
Practice Address - Country:US
Practice Address - Phone:303-326-0900
Practice Address - Fax:303-326-0006
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3466101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor