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Individual

LAURIE LYNNE DIEM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
D.O.

Contact information

Practice address
751 NE BLAKELY DR, STE 5010, ISSAQUAH, WA 98029-6201
(425) 394-0700
(425) 394-0701
Mailing address
PO BOX 25608, SALT LAKE CITY, UT 84125-0608
(206) 320-4476
(206) 568-7043

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
20A7699
CA
208000000X
Pediatrics Physician
Primary
OP60270441
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00AX76990
CA
Enumeration date
03/10/2006
Last updated
06/13/2014
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