Provider Demographics
NPI:1053536318
Name:BERNETT, DEANNE MARIE (LMP)
Entity type:Individual
Prefix:MS
First Name:DEANNE
Middle Name:MARIE
Last Name:BERNETT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 176TH ST S
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-4616
Mailing Address - Country:US
Mailing Address - Phone:253-539-0132
Mailing Address - Fax:
Practice Address - Street 1:129 176TH ST S
Practice Address - Street 2:SUITE A
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-4616
Practice Address - Country:US
Practice Address - Phone:253-539-0132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022744225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist