Provider Demographics
NPI:1134309735
Name:PUTTS, DEANNA IRENE (LMP)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:IRENE
Last Name:PUTTS
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 1:797 N ALMA SCHOOL RD STE B-2
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-3613
Mailing Address - Country:US
Mailing Address - Phone:253-508-6049
Mailing Address - Fax:
Practice Address - Street 1:797 N ALMA SCHOOL RD STE B-2
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-3613
Practice Address - Country:US
Practice Address - Phone:253-508-6049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022823174400000X
AZMT-28283174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00022823OtherL.M.P.