Provider Demographics
NPI:1215399324
Name:DEAL, KIANA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:KIANA
Middle Name:MARIE
Last Name:DEAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KIANA
Other - Middle Name:MARIE
Other - Last Name:OCHSENDORF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:410 S LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56515-4238
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:410 S LAKE AVE
Practice Address - Street 2:
Practice Address - City:BATTLE LAKE
Practice Address - State:MN
Practice Address - Zip Code:56515-4238
Practice Address - Country:US
Practice Address - Phone:218-864-5283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2456363A00000X
MN12094363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant