Healthcare Provider Details

I. General information

NPI: 1942382882
Provider Name (Legal Business Name): DIANE MARIE HURLEY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 EAST MAIN STREET
MOSSYROCK WA
98564
US

IV. Provider business mailing address

PO BOX 543
MOSSYROCK WA
98564-0543
US

V. Phone/Fax

Practice location:
  • Phone: 425-983-3668
  • Fax:
Mailing address:
  • Phone: 425-478-3525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN00067928
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: