Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | MD00031374 | WA |
N | 208G00000X | Cardiothoracic Vascular Surgeon | MD00031374 | WA |
NPI | 1023045101 |
---|---|
Provider Name | Angela Diamond |
First Address | Silverdale, WA 98383-8502 |
Second Address | Silverdale, WA 98383-7681 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 10/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1000530 | (05) | WA |
275079 | LABOR & INDUSTRIES (01) | WA |