Provider Demographics
NPI:1598961351
Name:WAARVIK, DIANE JEANNETTE (MSN, PNP)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:JEANNETTE
Last Name:WAARVIK
Suffix:
Gender:F
Credentials:MSN, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5120 QUEEN AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-2217
Mailing Address - Country:US
Mailing Address - Phone:612-922-1846
Mailing Address - Fax:612-928-1992
Practice Address - Street 1:2414 PARK AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3713
Practice Address - Country:US
Practice Address - Phone:612-879-8730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR063064-5363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics