1740461458 NPI number — MS. DIANE MICHELLE BASKIN-THOMPSON MN, ARNP, CNM

Table of content: MS. DIANE MICHELLE BASKIN-THOMPSON MN, ARNP, CNM (NPI 1740461458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740461458 NPI number — MS. DIANE MICHELLE BASKIN-THOMPSON MN, ARNP, CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BASKIN-THOMPSON
Provider First Name:
DIANE
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MN, ARNP, CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BASKIN
Provider Other First Name:
DIANE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1740461458
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11511 NE 10TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98004-8578
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-502-3000
Provider Business Mailing Address Fax Number:
425-502-3589

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11511 NE 10TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98004-8578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-502-3000
Provider Business Practice Location Address Fax Number:
425-502-3589
Provider Enumeration Date:
11/21/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LX0001X , with the licence number:  AP30005343 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9626755 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".