Basic Information
| Provider Information | |||||||||
| NPI: | 1275507105 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ENGELBRECHT | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19020 33RD AVE W | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | LYNNWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980364746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4255631500 | ||||||||
| FaxNumber: | 4255631374 | ||||||||
| Practice Location | |||||||||
| Address1: | 19020 33RD AVE W | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | LYNNWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980364746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4255631500 | ||||||||
| FaxNumber: | 4255631501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 03/20/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD00031424 | WA | N | Other Service Providers | Specialist | 2085R0202X | MD00031424 | WA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1006476 | 05 | WA | MEDICAID | 349480 | 01 | WA | L&I-EVERGREEN RADIA | OTHER | 8150294 | 05 | WA | MEDICAID | 300064814 | 01 | RAILROAD MEDICARE | OTHER | 109082 | 01 | WA | L&I | OTHER | EN3948 | 01 | WA | REGENCE | OTHER | 349474 | 01 | WA | L&I-RADIA KING COUNTY | OTHER | 349476 | 01 | WA | L&I-SWEDISH RADIA | OTHER | 0870618 | 01 | AETNA | OTHER | 349478 | 01 | WA | L&I-RADIA REST OF WA | OTHER | 8919495 | 01 | WA | CRIME VICTIMS | OTHER |