Provider Demographics
NPI:1689976813
Name:DEMALINE, ASHLEY MEGAN
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MEGAN
Last Name:DEMALINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 557
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-0557
Mailing Address - Country:US
Mailing Address - Phone:206-552-6992
Mailing Address - Fax:206-829-9660
Practice Address - Street 1:11820 NORTHUP WAY
Practice Address - Street 2:SUITE E226
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1946
Practice Address - Country:US
Practice Address - Phone:206-552-6992
Practice Address - Fax:206-829-9660
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-19
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60190843363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology