Individual
FATIMA JANETH DEALY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1401 N 10TH AVE STE 100, STAYTON, OR 97383-1486
(503) 769-2175
(503) 769-5877
Mailing address
PO BOX 577, STAYTON, OR 97383-0577
(503) 769-2175
(503) 769-3472
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA157447
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500644586
—
OR
Enumeration date
02/17/2012
Last updated
01/26/2024
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