Provider Demographics
NPI:1538516331
Name:WAY, DEANNA LEA (RN)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:LEA
Last Name:WAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:LEA
Other - Last Name:GILLAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 502
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OR
Mailing Address - Zip Code:97004-0502
Mailing Address - Country:US
Mailing Address - Phone:503-632-5692
Mailing Address - Fax:
Practice Address - Street 1:22062 S FERGUSON RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OR
Practice Address - Zip Code:97004-7625
Practice Address - Country:US
Practice Address - Phone:503-632-5692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-21
Last Update Date:2016-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR090007472RN163W00000X
WARN00162526163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse