Healthcare Provider Details

I. General information

NPI: 1114319928
Provider Name (Legal Business Name): AMBER N DAHNKE PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBER N MARTIN

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11511 CANTERWOOD BLVD STE 140
GIG HARBOR WA
98332-5817
US

IV. Provider business mailing address

11511 CANTERWOOD BLVD STE 140
GIG HARBOR WA
98332-5817
US

V. Phone/Fax

Practice location:
  • Phone: 253-530-2940
  • Fax: 253-530-2970
Mailing address:
  • Phone: 253-530-2940
  • Fax: 253-530-2970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60702539
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA60702539
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: