Healthcare Provider Details

I. General information

NPI: 1093635047
Provider Name (Legal Business Name): JILL KATHLEEN DIEGO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 S 2ND AVE
WALLA WALLA WA
99362-4118
US

IV. Provider business mailing address

654 N DIVISION ST
WALLA WALLA WA
99362-1404
US

V. Phone/Fax

Practice location:
  • Phone: 509-897-3700
  • Fax: 509-897-5575
Mailing address:
  • Phone: 509-897-3700
  • Fax: 509-897-5575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRN60738716
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: