MEDICARE: DIANE E WATSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	200241725RN	OR
2	363L00000X	Nurse Practitioner	AP61624187	WA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP61624187	WA

General Provider Information

NPI Number	:	1457128068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE E WATSON

Provider Business Mailing Address
First Line	:	12 NE FREMONT ST UNIT 3W
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-1166
Country	:	US
Telephone Number	:	503-998-5415
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 AURORA AVE N STE 360
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-8721
Country	:	US
Telephone Number	:	206-429-5029
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2023
Last Update Date	:	03/31/2025

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Directions to “ DIANE E WATSON ” Practice Location

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