Provider Demographics
NPI:1295177186
Name:MCDONALD, DIANNE MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:DIANNE
Middle Name:MARIE
Last Name:MCDONALD
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 1:6607 W OCTAVE ST
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-2084
Mailing Address - Country:US
Mailing Address - Phone:509-546-0929
Mailing Address - Fax:509-546-0929
Practice Address - Street 1:6607 W OCTAVE ST
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-2084
Practice Address - Country:US
Practice Address - Phone:509-546-0929
Practice Address - Fax:509-546-0929
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00089580163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA494544OtherSSPS PAYEE NUMBER