Provider Demographics
NPI:1780030247
Name:FLEURY, DESIREE (LMT)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:FLEURY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 E EVERGREEN BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-4900
Mailing Address - Country:US
Mailing Address - Phone:360-909-1470
Mailing Address - Fax:
Practice Address - Street 1:2727 E EVERGREEN BLVD STE F
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-4900
Practice Address - Country:US
Practice Address - Phone:360-909-1470
Practice Address - Fax:360-859-1411
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60656514174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist