Healthcare Provider Details

I. General information

NPI: 1821144023
Provider Name (Legal Business Name): DIANE M HENRY RN,CNOR,CRNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DIANE M OLSEN RN,CNOR,CRNFA

II. Dates (important events)

Enumeration Date: 01/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3816 48TH AVE NE
TACOMA WA
98422-2472
US

IV. Provider business mailing address

PO BOX 3544
FEDERAL WAY WA
98063-3544
US

V. Phone/Fax

Practice location:
  • Phone: 253-925-5194
  • Fax:
Mailing address:
  • Phone: 253-925-5194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number025801RN00071286
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: