Provider Demographics
NPI:1639207624
Name:PATNODE, DIANE L (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:L
Last Name:PATNODE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19379 7TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-7504
Mailing Address - Country:US
Mailing Address - Phone:360-394-1000
Mailing Address - Fax:
Practice Address - Street 1:19379 7TH AVE NE
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7504
Practice Address - Country:US
Practice Address - Phone:360-394-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00030217207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8216111Medicaid
WAG8872502Medicare PIN
WAG000135826Medicare PIN
WAG8883386Medicare PIN
WAF17873Medicare UPIN
WAGAB22455Medicare PIN