Provider Demographics
NPI:1902177850
Name:KOVAC, DIANE MARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:KOVAC
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:MARIE
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:509-227-7070
Practice Address - Street 1:101 W 8TH AVE STE 560E
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2307
Practice Address - Country:US
Practice Address - Phone:509-474-6920
Practice Address - Fax:509-227-7070
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60085467163W00000X
WAAP61312337363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse