Healthcare Provider Details

I. General information

NPI: 1679622344
Provider Name (Legal Business Name): DEANA DAHL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 09/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 JUNE ST STE 104
HOOD RIVER OR
97031-1516
US

IV. Provider business mailing address

PO BOX 1519
WHITE SALMON WA
98672
US

V. Phone/Fax

Practice location:
  • Phone: 541-386-3626
  • Fax:
Mailing address:
  • Phone: 509-493-2133
  • Fax: 509-493-9544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30005441
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: