Provider Demographics
NPI:1013198266
Name:BEELER, DEOLIA DEANN (LMP)
Entity Type:Individual
Prefix:MISS
First Name:DEOLIA
Middle Name:DEANN
Last Name:BEELER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1152
Mailing Address - Street 2:
Mailing Address - City:OLALLA
Mailing Address - State:WA
Mailing Address - Zip Code:98359-1152
Mailing Address - Country:US
Mailing Address - Phone:253-222-9319
Mailing Address - Fax:
Practice Address - Street 1:3561 NW ANDERSON HILL RD
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9130
Practice Address - Country:US
Practice Address - Phone:360-692-4264
Practice Address - Fax:360-692-4277
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024840390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program