Provider Demographics
NPI:1184884660
Name:SIMONS, DIANE LYNN (CO, LO)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:LYNN
Last Name:SIMONS
Suffix:
Gender:F
Credentials:CO, LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4800 SANDPOINT WAY NE
Mailing Address - Street 2:CHILDREN'S HOSPITAL & REGIONAL MEDICAL CENTER
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105
Mailing Address - Country:US
Mailing Address - Phone:206-987-3171
Mailing Address - Fax:206-987-5520
Practice Address - Street 1:4800 SANDPOINT WAY NE
Practice Address - Street 2:MS W4657
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-0371
Practice Address - Country:US
Practice Address - Phone:206-987-3171
Practice Address - Fax:206-987-5520
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOI 00000012174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist