MEDICARE: MS. DIANE GRACE HUTCHESON ARNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP30004654	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HU6630	OTHER	WA	REGENCE BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	133122100000	OTHER	WA	PREMERA BLUE CROSS

General Provider Information

NPI Number	:	1992889174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIANE GRACE HUTCHESON ARNP

Provider Business Mailing Address
First Line	:	126 SW 148TH ST
Second Line	:	SUITE C100-334
City	:	BURIEN
State	:	WA
Zip	:	98166-1984
Country	:	US
Telephone Number	:	206-841-2126
Fax Number	:	206-932-4856

Provider Business Practice Location Address
First Line	:	6959 CALIFORNIA AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98136-1953
Country	:	US
Telephone Number	:	206-841-2126
Fax Number	:	206-932-4856

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	12/03/2009

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