Provider Demographics
NPI:1831176999
Name:DEHAAN, HELENE SUSAN (FNP)
Entity type:Individual
Prefix:MS
First Name:HELENE
Middle Name:SUSAN
Last Name:DEHAAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 3RD ST SE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3742
Mailing Address - Country:US
Mailing Address - Phone:253-841-8939
Mailing Address - Fax:253-445-0756
Practice Address - Street 1:1519 3RD ST SE
Practice Address - Street 2:SUITE 101
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3742
Practice Address - Country:US
Practice Address - Phone:253-841-8939
Practice Address - Fax:253-445-0756
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX671697363LF0000X
WAAP60184955363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156621801Medicaid
TX156621802Medicaid
TX156621804Medicaid
TX156621805Medicaid
TX156621806Medicaid
TXP00204887OtherRAILROAD
TX8N3351OtherBLUE CROSS BLUE SHIELD
TX156621803Medicaid
TXP00204887OtherRAILROAD
TX156621802Medicaid
TX8L21802Medicare PIN
TX156621805Medicaid
TX8L21790Medicare PIN
S66493Medicare UPIN
TX156621804Medicaid
TX8A3773Medicare PIN