Healthcare Provider Details

I. General information

NPI: 1053358465
Provider Name (Legal Business Name): DEANNA D. DAVIDSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEANNA D. HUNTWORK DO

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 3RD ST SUITE 4
DAVENPORT WA
99122-9730
US

IV. Provider business mailing address

100 3RD ST SUITE 1
DAVENPORT WA
99122-9730
US

V. Phone/Fax

Practice location:
  • Phone: 509-725-6560
  • Fax: 509-725-1509
Mailing address:
  • Phone: 509-725-7501
  • Fax: 509-725-7504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOP00001498
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: