Provider Demographics
NPI:1457066482
Name:DOAN, VIVIAN MAI (CRNA)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:MAI
Last Name:DOAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 840842
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0842
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:972-715-9976
Practice Address - Street 1:600 BROADWAY STE 270
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5392
Practice Address - Country:US
Practice Address - Phone:206-625-0578
Practice Address - Fax:206-625-9184
Is Sole Proprietor?:No
Enumeration Date:2023-01-13
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX141173367500000X
WAAP61399620367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered