Healthcare Provider Details

I. General information

NPI: 1538354170
Provider Name (Legal Business Name): MICHELE RENEE VANDERLIN DMSC, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 164TH AVE NE STE 200
REDMOND WA
98052-7615
US

IV. Provider business mailing address

8201 164TH AVE NE STE 200
REDMOND WA
98052-7615
US

V. Phone/Fax

Practice location:
  • Phone: 360-340-9838
  • Fax: 360-325-4399
Mailing address:
  • Phone: 360-340-9838
  • Fax: 360-325-4399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61263914
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3646
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: