Provider Demographics
NPI:1598941635
Name:FENDER, DIANA (LMP)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:
Last Name:FENDER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39636 SE SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-9554
Mailing Address - Country:US
Mailing Address - Phone:206-251-3435
Mailing Address - Fax:
Practice Address - Street 1:39636 SE SPRUCE ST
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-9554
Practice Address - Country:US
Practice Address - Phone:206-251-3435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-19
Last Update Date:2008-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022691174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist