Individual
DESLA REY MANTEUFFEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
901 BOREN AVE STE 1650, SEATTLE, WA 98104-3508
(206) 215-6221
(206) 215-6340
Mailing address
PO BOX 25608, SALT LAKE CITY, UT 84125-0608
(206) 320-4476
(206) 568-7043
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA61042077
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2154963
—
WA
Enumeration date
08/28/2012
Last updated
12/02/2022
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