Provider Demographics
NPI:1063197820
Name:HORTON, DIANA JO
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:JO
Last Name:HORTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:JO
Other - Last Name:FAFNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14090 FRYELANDS BLVD SE STE 347
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-2760
Mailing Address - Country:US
Mailing Address - Phone:360-805-3122
Mailing Address - Fax:360-805-9180
Practice Address - Street 1:14090 FRYELANDS BLVD SE STE 347
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-2760
Practice Address - Country:US
Practice Address - Phone:360-805-3122
Practice Address - Fax:360-805-9180
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator