Provider Demographics
NPI:1457579757
Name:DEAN, DEANNA MARSHAN (LMP)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:MARSHAN
Last Name:DEAN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20312 104TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-2409
Mailing Address - Country:US
Mailing Address - Phone:206-550-3800
Mailing Address - Fax:
Practice Address - Street 1:20312 104TH AVE NE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-2409
Practice Address - Country:US
Practice Address - Phone:206-550-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020594225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist