Provider Demographics
NPI:1306013271
Name:KEITH, DEEANNA (LMP)
Entity Type:Individual
Prefix:MRS
First Name:DEEANNA
Middle Name:
Last Name:KEITH
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 1:10511B 224TH AVE E
Mailing Address - Street 2:
Mailing Address - City:BUCKLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98321-9251
Mailing Address - Country:US
Mailing Address - Phone:253-334-7847
Mailing Address - Fax:253-299-6205
Practice Address - Street 1:10511B 224TH AVE E
Practice Address - Street 2:
Practice Address - City:BUCKLEY
Practice Address - State:WA
Practice Address - Zip Code:98321-9251
Practice Address - Country:US
Practice Address - Phone:253-334-7847
Practice Address - Fax:253-299-6205
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-10
Last Update Date:2008-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020351174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist