Individual
BRANDI JO DESAVEUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
911 W. 5TH AVE., SPOKANE, WA 99204
(509) 455-7844
(509) 623-0415
Mailing address
PO BOX 8500 LOCKBOX 7642, PHILADELPHIA, PA 19178-7642
(813) 281-8115
(813) 281-8656
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10005083
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0234704
L&I
WA
01
—
80768780
ID MEDICAID
WA
01
—
8799DE
ASURIS
WA
01
—
P00613585
RR MEDICARE
WA
Enumeration date
10/16/2006
Last updated
08/15/2018
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