Provider Demographics
NPI:1225847700
Name:VAN DENEND, DYLAN
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:VAN DENEND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 S NEWER RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99037-9726
Mailing Address - Country:US
Mailing Address - Phone:303-919-7792
Mailing Address - Fax:
Practice Address - Street 1:200 E BARKER ST
Practice Address - Street 2:
Practice Address - City:MEDICAL LAKE
Practice Address - State:WA
Practice Address - Zip Code:99022-9003
Practice Address - Country:US
Practice Address - Phone:509-565-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1682944163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool