Provider Demographics
NPI:1902285216
Name:RILEY, DEANNA KAY (LPN)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:KAY
Last Name:RILEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1086 S.W 12TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98164-1381
Mailing Address - Country:US
Mailing Address - Phone:253-495-6845
Mailing Address - Fax:
Practice Address - Street 1:300 SW 7TH ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2307
Practice Address - Country:US
Practice Address - Phone:425-204-2422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60118025164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse