Provider Demographics
NPI:1720285950
Name:NAUER, M DIANNE (ARNP)
Entity type:Individual
Prefix:
First Name:M
Middle Name:DIANNE
Last Name:NAUER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MILDRED
Other - Middle Name:DIANNE
Other - Last Name:IVIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3808 122ND AVE E
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98372
Mailing Address - Country:US
Mailing Address - Phone:253-863-0519
Mailing Address - Fax:
Practice Address - Street 1:6212 75TH ST W
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499
Practice Address - Country:US
Practice Address - Phone:253-279-3528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005157363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner