Provider Demographics
NPI:1700957347
Name:EDWARDS, DIANE RENEE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:RENEE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:DIANE
Other - Middle Name:HASNESS
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:8929 131ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-9061
Mailing Address - Country:US
Mailing Address - Phone:360-563-9007
Mailing Address - Fax:
Practice Address - Street 1:500 5TH AVE
Practice Address - Street 2:6W
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2332
Practice Address - Country:US
Practice Address - Phone:206-296-1091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30000718363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8563603Medicaid
WA8563603Medicaid
ME0694338OtherDEA