Provider Demographics
NPI:1780768564
Name:PHINNEY, DEANA MARLOR
Entity type:Individual
Prefix:
First Name:DEANA
Middle Name:MARLOR
Last Name:PHINNEY
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 1:1959 NE PACIFIC ST
Mailing Address - Street 2:UW BOX 356310
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-6310
Mailing Address - Country:US
Mailing Address - Phone:206-277-3805
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:UW BOX 356310
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-6310
Practice Address - Country:US
Practice Address - Phone:206-277-3805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004014363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB19738Medicare ID - Type Unspecified
WAG02465Medicare UPIN