Provider Demographics
NPI:1275975559
Name:NEILSON, DIANNE (DIANNE NEILSON, RN)
Entity Type:Individual
Prefix:MRS
First Name:DIANNE
Middle Name:
Last Name:NEILSON
Suffix:
Gender:F
Credentials:DIANNE NEILSON, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22829 77TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-9534
Mailing Address - Country:US
Mailing Address - Phone:206-940-9401
Mailing Address - Fax:
Practice Address - Street 1:22829 77TH AVE SE
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-9534
Practice Address - Country:US
Practice Address - Phone:206-940-9401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00132690163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA163W00000XMedicaid