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General NPI Number Information
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NPI Number | 1366523490
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Entity Type | Individual
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Provider Name | DONNA M LANDRY PHYSICIAN ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1603 COOPER POINT RD NW
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City | OLYMPIA
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State | WA
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Zip | 98502-8325
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Country | US
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Telephone | 360-753-0396
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Fax | 360-539-7937
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Provider Business Mailing Address
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Address Line | 1603 COOPER POINT RD NW
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City | OLYMPIA
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State | WA
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Zip | 98502-8325
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Country | US
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Telephone | 360-753-0396
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Fax | 360-539-7937
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA10002558
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License Number State | WA
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