Provider Demographics
NPI:1053723320
Name:ZANDER, DIANNA
Entity type:Individual
Prefix:
First Name:DIANNA
Middle Name:
Last Name:ZANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 RIVER RIDGE DRIVE SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98513
Mailing Address - Country:US
Mailing Address - Phone:360-412-4830
Mailing Address - Fax:360-412-4839
Practice Address - Street 1:350 RIVER RIDGE DR SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98513-6830
Practice Address - Country:US
Practice Address - Phone:360-412-4830
Practice Address - Fax:360-412-4839
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00068489163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool