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ELEANOR A DESHONE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1400 E KINCAID ST, MOUNT VERNON, WA 98274-4127
(360) 814-6565
(360) 814-6380
Mailing address
1400 E KINCAID ST, MOUNT VERNON, WA 98274-4127

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
MA057879
PA
363AS0400X
Surgical Physician Assistant
Primary
PA61501376
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
13676814
CAQH
Enumeration date
10/23/2015
Last updated
05/08/2024
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