Provider Demographics
NPI:1205550522
Name:CASTRO, DANA VIEIRA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:VIEIRA
Last Name:CASTRO
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:CASTRO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:2022 BROWN ST SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-3164
Mailing Address - Country:US
Mailing Address - Phone:360-918-8915
Mailing Address - Fax:
Practice Address - Street 1:2747 PACIFIC AVE SE STE B19
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-2094
Practice Address - Country:US
Practice Address - Phone:360-481-7477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61365231363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health