Healthcare Provider Details

I. General information

NPI: 1699747717
Provider Name (Legal Business Name): DIANE LORRAINE HANKS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DIANE LORRAINE BUSHNELL ARNP

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 GAGE BLVD STE 100
RICHLAND WA
99352
US

IV. Provider business mailing address

488 ANTHONY DR
RICHLAND WA
99352-9505
US

V. Phone/Fax

Practice location:
  • Phone: 509-491-1120
  • Fax: 509-987-1011
Mailing address:
  • Phone: 509-438-2235
  • Fax: 509-987-1011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP662A
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP662A
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP60298638
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: