Provider Demographics
NPI:1891068169
Name:DEALY, FATIMA JANETH (PA-C)
Entity Type:Individual
Prefix:
First Name:FATIMA
Middle Name:JANETH
Last Name:DEALY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:FATIMA
Other - Middle Name:JANETH
Other - Last Name:BAAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 577
Mailing Address - Street 2:
Mailing Address - City:STAYTON
Mailing Address - State:OR
Mailing Address - Zip Code:97383-0577
Mailing Address - Country:US
Mailing Address - Phone:503-769-2175
Mailing Address - Fax:503-769-3472
Practice Address - Street 1:1401 N 10TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:STAYTON
Practice Address - State:OR
Practice Address - Zip Code:97383-1486
Practice Address - Country:US
Practice Address - Phone:503-769-2175
Practice Address - Fax:503-769-5877
Is Sole Proprietor?:No
Enumeration Date:2012-02-17
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA157447363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500644586Medicaid