Provider Demographics
NPI:1609146471
Name:DIAZ, MYRA ANNE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:MYRA
Middle Name:ANNE
Last Name:DIAZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:MYRA
Other - Middle Name:ANNE
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:921 N J ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-2123
Mailing Address - Country:US
Mailing Address - Phone:253-324-7258
Mailing Address - Fax:253-507-4587
Practice Address - Street 1:921 N J ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-2123
Practice Address - Country:US
Practice Address - Phone:253-324-7258
Practice Address - Fax:253-507-4587
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60119686163W00000X
WAAP60261877363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse