Provider Demographics
NPI:1306473103
Name:MEHLHOFF, DEANNA JAYE (FNP-BC)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:JAYE
Last Name:MEHLHOFF
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18622 94TH AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-9644
Mailing Address - Country:US
Mailing Address - Phone:253-330-1049
Mailing Address - Fax:
Practice Address - Street 1:18622 94TH AVENUE CT E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-9644
Practice Address - Country:US
Practice Address - Phone:253-330-1049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61051726363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily