Provider Demographics
NPI:1699747717
Name:HANKS, DIANE LORRAINE (ARNP)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:LORRAINE
Last Name:HANKS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:LORRAINE
Other - Last Name:BUSHNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:488 ANTHONY DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9505
Mailing Address - Country:US
Mailing Address - Phone:509-438-2235
Mailing Address - Fax:509-987-1011
Practice Address - Street 1:705 GAGE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352
Practice Address - Country:US
Practice Address - Phone:509-491-1120
Practice Address - Fax:509-987-1011
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP662A363LF0000X, 363LP0808X
WAAP60298638363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807061900Medicaid
WA1699747717Medicaid
ID807061900Medicaid
ID1344998Medicare ID - Type Unspecified