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General NPI Number Information
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NPI Number | 1215399324
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Entity Type | Individual
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Provider Name | KIANA MARIE DEAL PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/28/2016
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Last Update Date | 09/22/2016
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Provider Practice Location Address
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Address Line | 410 S LAKE AVE
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City | BATTLE LAKE
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State | MN
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Zip | 56515-4238
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Country | US
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Telephone | 218-864-5283
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Fax |
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Provider Business Mailing Address
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Address Line | 410 S LAKE AVE
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City | BATTLE LAKE
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State | MN
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Zip | 56515-4238
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2456
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 12094
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License Number State | MN
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