Provider Demographics
NPI:1528039757
Name:DEVITA, DIANE
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:DEVITA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1802 FISHER AVE
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-8723
Mailing Address - Country:US
Mailing Address - Phone:253-964-7403
Mailing Address - Fax:253-968-2550
Practice Address - Street 1:MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-1250
Practice Address - Fax:253-968-2550
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00041868207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine