Healthcare Provider Details

I. General information

NPI: 1407901200
Provider Name (Legal Business Name): MICHELLE DIANE DOSA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 05/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2102 N PEARL ST SUITE 405
TACOMA WA
98406-2530
US

IV. Provider business mailing address

2102 N PEARL ST SUITE 405
TACOMA WA
98406-2530
US

V. Phone/Fax

Practice location:
  • Phone: 253-752-8833
  • Fax: 253-752-5400
Mailing address:
  • Phone: 253-752-8833
  • Fax: 253-752-5400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP30004710
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: