Provider Demographics
NPI:1366523490
Name:LANDRY, DONNA M (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:M
Last Name:LANDRY
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1603 COOPER POINT RD NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8325
Mailing Address - Country:US
Mailing Address - Phone:360-753-0396
Mailing Address - Fax:360-539-7937
Practice Address - Street 1:1603 COOPER POINT RD NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8325
Practice Address - Country:US
Practice Address - Phone:360-753-0396
Practice Address - Fax:360-539-7937
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10002558363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
5617199OtherAETNA NON HMO
OA10000203OtherWASH ST LICENSE
3568326OtherAETNA HMO
O198234OtherLABOR & INDUSTRIES
2007LAOtherREGENCE
A1820OtherPREMERA BC
A1820OtherPREMERA BC
OA10000203OtherWASH ST LICENSE
O198234OtherLABOR & INDUSTRIES