Healthcare Provider Details

I. General information

NPI: 1841809191
Provider Name (Legal Business Name): DEANETTE JAMES PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BROADWAY STE 100
TACOMA WA
98402-3900
US

IV. Provider business mailing address

401 BROADWAY STE 100
TACOMA WA
98402-3900
US

V. Phone/Fax

Practice location:
  • Phone: 253-285-1134
  • Fax: 253-237-9372
Mailing address:
  • Phone: 253-285-1134
  • Fax: 253-237-9372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number890866
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN61232446
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1056043
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61253063
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: