Provider Demographics
NPI:1356378186
Name:BENEDICT, DEONNE JEANETTE (ARNP)
Entity type:Individual
Prefix:DR
First Name:DEONNE
Middle Name:JEANETTE
Last Name:BENEDICT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:DR
Other - First Name:DEONNE
Other - Middle Name:JEANETTE
Other - Last Name:BROWN BENEDICT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:23601 HWY 99 STE A
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-9212
Mailing Address - Country:US
Mailing Address - Phone:206-714-4476
Mailing Address - Fax:
Practice Address - Street 1:23601 HWY 99 STE A
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-9212
Practice Address - Country:US
Practice Address - Phone:206-714-4476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN0116547163WG0000X
WAAP30004155363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice