Provider Demographics
NPI:1225842602
Name:ALLEN, DIANA LYNN (APRN)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30799 LUDLOW DR NE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:WA
Mailing Address - Zip Code:98346-7645
Mailing Address - Country:US
Mailing Address - Phone:136-088-8471
Mailing Address - Fax:
Practice Address - Street 1:30799 LUDLOW DR NE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:WA
Practice Address - Zip Code:98346-7645
Practice Address - Country:US
Practice Address - Phone:360-908-5843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30002159363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology