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General NPI Number Information
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NPI Number | 1992571657
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Entity Type | Individual
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Provider Name | DIANE SYLVIA WARREN TATTOO ARTIST
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Gender | Female
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Dates
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Enumeration Date | 12/04/2023
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 201 NE PARK PLAZA DR STE 246
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City | VANCOUVER
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State | WA
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Zip | 98684-5874
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Country | US
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Telephone | 360-936-7380
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Fax |
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Provider Business Mailing Address
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Address Line | 11943 NE 109TH WAY
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City | VANCOUVER
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State | WA
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Zip | 98662-3423
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Country | US
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Telephone | 360-936-7380
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 2417
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License Number State | WA
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