Provider Demographics
NPI:1992889174
Name:HUTCHESON, DIANE GRACE (ARNP)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:GRACE
Last Name:HUTCHESON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 SW 148TH ST
Mailing Address - Street 2:SUITE C100-334
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1984
Mailing Address - Country:US
Mailing Address - Phone:206-841-2126
Mailing Address - Fax:206-932-4856
Practice Address - Street 1:6959 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1953
Practice Address - Country:US
Practice Address - Phone:206-841-2126
Practice Address - Fax:206-932-4856
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004654363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAHU6630OtherREGENCE BLUE SHIELD
WA9625005Medicaid
WA133122100000OtherPREMERA BLUE CROSS
WAAB10765Medicare ID - Type Unspecified
WA133122100000OtherPREMERA BLUE CROSS