Provider Demographics
NPI:1982921540
Name:DENNISON, EVELYN A (MD)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:A
Last Name:DENNISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10526 NE 68TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-7004
Mailing Address - Country:US
Mailing Address - Phone:425-947-1303
Mailing Address - Fax:425-576-1234
Practice Address - Street 1:10526 NE 68TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-7004
Practice Address - Country:US
Practice Address - Phone:425-947-1303
Practice Address - Fax:425-576-1234
Is Sole Proprietor?:No
Enumeration Date:2010-04-22
Last Update Date:2016-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NDPT129702084P0800X
ND129702084P0800X
WAMD605339112084P0802X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND18272Medicaid
ND18272Medicaid
NDN719384Medicare UPIN