Provider Demographics
NPI:1891493573
Name:DIEPEVEEN, SARAH LYNNE (RN)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:LYNNE
Last Name:DIEPEVEEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 NENANT ST S # 315
Mailing Address - Street 2:
Mailing Address - City:BUCODA
Mailing Address - State:WA
Mailing Address - Zip Code:98530-4506
Mailing Address - Country:US
Mailing Address - Phone:253-330-9648
Mailing Address - Fax:
Practice Address - Street 1:3436 MARY ELDER RD NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5050
Practice Address - Country:US
Practice Address - Phone:360-528-2590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61179949163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse