Deidre Ann Mance, ARNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP61098433 Issued in WA

Practice address

2120 Ryan Rd
Buckley, WA 98321-9115

Phone

(360) 829-1111

NPI assigned

Oct 15, 2020

Last updated

Oct 15, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Rainier State School

  • Intellectual Disabilities Intermediate Care Facility
  • Buckley, WA
  • NPI 1164547626
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1602720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602720000000",
    "number": "1205434701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1377",
            "city": "BUCKLEY",
            "state": "WA",
            "postal_code": "983211377",
            "telephone_number": "253-740-5964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2120 RYAN RD",
            "city": "BUCKLEY",
            "state": "WA",
            "postal_code": "983219115",
            "telephone_number": "360-829-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANCE",
        "first_name": "DEIDRE",
        "middle_name": "ANN",
        "credential": "ARNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-15",
        "last_updated": "2020-10-15",
        "certification_date": "2020-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP61098433",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Marie Lambert, LMP
• Genevieve Monet Lawrence, R.N.
• Sherrae Lewis, LPN
• William P Loomis, D.C.
• Kristina Michelle Mahan-Sawvell, D.C.
• Kaylee R McDonald, N.D.
• Daniel James McNabb, D.C.
• Mariena Mears
• Ebrahim Mirjalili, DDS
• Karine Mish, RN

• Family Nurse Practitioner in Buckley, WA
• Providers in Buckley, WA by specialty
• Family Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.