Provider Demographics
NPI:1851609671
Name:EVERETT, DIANE (RN)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:
Last Name:EVERETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11491 CRANBERRY HILL CT
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8592
Mailing Address - Country:US
Mailing Address - Phone:801-576-4288
Mailing Address - Fax:
Practice Address - Street 1:11491 CRANBERRY HILL CT
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-8592
Practice Address - Country:US
Practice Address - Phone:801-576-4288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7301162-3102163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent