Healthcare Provider Details

I. General information

NPI: 1740461458
Provider Name (Legal Business Name): DIANE MICHELLE BASKIN-THOMPSON MN, ARNP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANE BASKIN

II. Dates (important events)

Enumeration Date: 11/21/2007
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11511 NE 10TH ST
BELLEVUE WA
98004-8578
US

IV. Provider business mailing address

11511 NE 10TH ST
BELLEVUE WA
98004-8578
US

V. Phone/Fax

Practice location:
  • Phone: 425-502-3000
  • Fax: 425-502-3589
Mailing address:
  • Phone: 425-502-3000
  • Fax: 425-502-3589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAP30005343
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: