Provider Demographics
NPI:1821279381
Name:MARKLEY, DEANNA LYNN (PA)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:LYNN
Last Name:MARKLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12040 S LAKES DR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-1246
Mailing Address - Country:US
Mailing Address - Phone:703-464-0686
Mailing Address - Fax:703-464-0698
Practice Address - Street 1:12040 S LAKES DR
Practice Address - Street 2:SUITE 207
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-1246
Practice Address - Country:US
Practice Address - Phone:703-464-0686
Practice Address - Fax:703-703-6406
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110840512363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical