Healthcare Provider Details

I. General information

NPI: 1568601995
Provider Name (Legal Business Name): DEANNA KAY BLEVINS LMP, CR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2009
Last Update Date: 07/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2917 WASHINGTON ST SUITE 104
VANCOUVER WA
98660-2258
US

IV. Provider business mailing address

409 W 25TH ST
VANCOUVER WA
98660-2547
US

V. Phone/Fax

Practice location:
  • Phone: 360-609-8707
  • Fax:
Mailing address:
  • Phone: 360-609-8707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00023072
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberCERTIFIED
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: