Provider Demographics
NPI:1760342620
Name:HENRY, DIANE L (RN, IBCLC)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:L
Last Name:HENRY
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 CLEMENT ST APT 203
Mailing Address - Street 2:
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-8482
Mailing Address - Country:US
Mailing Address - Phone:970-948-8796
Mailing Address - Fax:
Practice Address - Street 1:201 CLEMENT ST APT 203
Practice Address - Street 2:
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-8482
Practice Address - Country:US
Practice Address - Phone:970-948-8796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-13
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO128860163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty