Healthcare Provider Details

I. General information

NPI: 1023413358
Provider Name (Legal Business Name): DIANA BARTLETT MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2014
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 13TH ST STE 300
EVERETT WA
98201
US

IV. Provider business mailing address

PO BOX 5127
EVERETT WA
98206-5127
US

V. Phone/Fax

Practice location:
  • Phone: 425-297-5560
  • Fax: 425-297-5561
Mailing address:
  • Phone: 425-297-5560
  • Fax: 425-297-5561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60516830
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP60516830
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: