Provider Demographics
NPI:1396117818
Name:DESHONE, ELEANOR A (PA-C)
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:A
Last Name:DESHONE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELEANOR
Other - Middle Name:A
Other - Last Name:CATALINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 E KINCAID ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 E KINCAID ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4127
Practice Address - Country:US
Practice Address - Phone:360-814-6565
Practice Address - Fax:360-814-6380
Is Sole Proprietor?:No
Enumeration Date:2015-10-23
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA057879363A00000X
WAPA61501376363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
13676814OtherCAQH
13676814OtherCAQH