Provider Demographics
NPI:1598819138
Name:MARTIN, DEANNA M (CRNA)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 9TH AVE
Mailing Address - Street 2:BOX 359724
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2499
Mailing Address - Country:US
Mailing Address - Phone:206-744-8491
Mailing Address - Fax:206-744-9773
Practice Address - Street 1:21401 72ND AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7702
Practice Address - Country:US
Practice Address - Phone:425-304-1101
Practice Address - Fax:425-412-1864
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007616367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9651951Medicaid
WA0218867OtherL&I PIN
WA87596UOtherREGENCE PIN
WA8864413Medicare PIN