Provider Demographics
NPI:1750544987
Name:SALYER, DEANNA (PA)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:SALYER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:
Other - Last Name:RUVOLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1431 CENTERPOINT BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-1984
Mailing Address - Country:US
Mailing Address - Phone:865-985-7012
Mailing Address - Fax:865-560-8943
Practice Address - Street 1:2 BERNARDINE DR
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-4404
Practice Address - Country:US
Practice Address - Phone:757-886-6000
Practice Address - Fax:757-886-6251
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002836363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAMC10556Medicare PIN