Provider Demographics
NPI:1740461458
Name:BASKIN-THOMPSON, DIANE MICHELLE (MN, ARNP, CNM)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:MICHELLE
Last Name:BASKIN-THOMPSON
Suffix:
Gender:F
Credentials:MN, ARNP, CNM
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:BASKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11511 NE 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-8578
Mailing Address - Country:US
Mailing Address - Phone:425-502-3000
Mailing Address - Fax:425-502-3589
Practice Address - Street 1:11511 NE 10TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-8578
Practice Address - Country:US
Practice Address - Phone:425-502-3000
Practice Address - Fax:425-502-3589
Is Sole Proprietor?:No
Enumeration Date:2007-11-21
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005343363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9626755Medicaid
WA9626755Medicaid
WAGAB13885Medicare PIN