Provider Demographics
NPI:1821144023
Name:HENRY, DIANE M (RN,CNOR,CRNFA)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:HENRY
Suffix:
Gender:F
Credentials:RN,CNOR,CRNFA
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:M
Other - Last Name:OLSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN,CNOR,CRNFA
Mailing Address - Street 1:PO BOX 3544
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98063-3544
Mailing Address - Country:US
Mailing Address - Phone:253-925-5194
Mailing Address - Fax:
Practice Address - Street 1:3816 48TH AVE NE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98422-2472
Practice Address - Country:US
Practice Address - Phone:253-925-5194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA025801RN00071286163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
158254100000OtherBLUE CROSS
WA0102455OtherL&I
0004332558OtherAETNA