1821144023 NPI number — DIANE M HENRY RN,CNOR,CRNFA

Table of content: DIANE M HENRY RN,CNOR,CRNFA (NPI 1821144023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821144023 NPI number — DIANE M HENRY RN,CNOR,CRNFA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENRY
Provider First Name:
DIANE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN,CNOR,CRNFA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OLSEN
Provider Other First Name:
DIANE
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN,CNOR,CRNFA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1821144023
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3544
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FEDERAL WAY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98063-3544
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-925-5194
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3816 48TH AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98422-2472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-925-5194
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/28/2007

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: 163WR0006X , with the licence number:  025801RN00071286 , 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: 158254100000 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0102455 . This is a "L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0004332558 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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