Provider Demographics
NPI:1740893379
Name:DEVANEY, DOROTHY LYNN
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:LYNN
Last Name:DEVANEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DOTTY
Other - Middle Name:LYNN
Other - Last Name:DEVANEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:17230 NE WOODINVILLE DUVALL RD
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-9674
Mailing Address - Country:US
Mailing Address - Phone:509-637-4311
Mailing Address - Fax:
Practice Address - Street 1:1033 SW 152ND ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-1845
Practice Address - Country:US
Practice Address - Phone:206-242-1698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program