MEDICARE: DEANA MARLOR PHINNEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	PA10004014	WA

General Provider Information

NPI Number	:	1780768564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANA MARLOR PHINNEY

Provider Business Mailing Address
First Line	:	1959 NE PACIFIC ST
Second Line	:	UW BOX 356310
City	:	SEATTLE
State	:	WA
Zip	:	98195-6310
Country	:	US
Telephone Number	:	206-277-3805
Fax Number	:

Provider Business Practice Location Address
First Line	:	1959 NE PACIFIC ST
Second Line	:	UW BOX 356310
City	:	SEATTLE
State	:	WA
Zip	:	98195-6310
Country	:	US
Telephone Number	:	206-277-3805
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	07/08/2007

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