Provider Demographics
NPI:1427419845
Name:DEAVER, KUWANNA (MSN,APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KUWANNA
Middle Name:
Last Name:DEAVER
Suffix:
Gender:F
Credentials:MSN,APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 WESTLAKE AVE N STE 700
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-3097
Mailing Address - Country:US
Mailing Address - Phone:866-821-0281
Mailing Address - Fax:
Practice Address - Street 1:3401 ENTERPRISE PKWY
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-7341
Practice Address - Country:US
Practice Address - Phone:866-237-6125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-12
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH025602363LP0808X
WAAP61007480363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health