Provider Demographics
NPI:1225000961
Name:TRUSEVICH, DIANA (ARNP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:TRUSEVICH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 E INDIANA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-2313
Mailing Address - Country:US
Mailing Address - Phone:509-241-4207
Mailing Address - Fax:506-444-3256
Practice Address - Street 1:123 E INDIANA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-2313
Practice Address - Country:US
Practice Address - Phone:509-241-4207
Practice Address - Fax:506-444-3256
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006363363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7922404Medicaid