Provider Demographics
NPI:1780724492
Name:MAIER, DIANE CASAMERA (LMP)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:CASAMERA
Last Name:MAIER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17105 NE 20TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-9709
Mailing Address - Country:US
Mailing Address - Phone:360-885-7655
Mailing Address - Fax:360-885-7655
Practice Address - Street 1:19111 SE 34TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-1448
Practice Address - Country:US
Practice Address - Phone:360-944-9441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAW00020974174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist