Provider Demographics
NPI:1083952527
Name:DIAZ, AMY MARIE (RN, ARNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:DIAZ
Suffix:
Gender:F
Credentials:RN, ARNP, FNP-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MARIE
Other - Last Name:MORSETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3360
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3360
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:615 LILLY RD NE STE 220
Practice Address - Street 2:PMG SW WA NEUROSURGERY
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5137
Practice Address - Country:US
Practice Address - Phone:360-486-6150
Practice Address - Fax:360-486-6155
Is Sole Proprietor?:No
Enumeration Date:2013-01-17
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60318377363LA2200X
WAAP 60318377363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2024514Medicaid