Provider Demographics
NPI:1861655391
Name:BIANCHI, DANA (LMP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:BIANCHI
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 DEL CAMPO DR
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-3405
Mailing Address - Country:US
Mailing Address - Phone:425-753-0321
Mailing Address - Fax:
Practice Address - Street 1:2320 DEL CAMPO DR
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-3405
Practice Address - Country:US
Practice Address - Phone:425-753-0321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024863174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist