Healthcare Provider Details

I. General information

NPI: 1164927646
Provider Name (Legal Business Name): DANIEL NATHAN MUNGER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NE MOTHER JOSEPH PL STE 300
VANCOUVER WA
98664-3296
US

IV. Provider business mailing address

200 NE MOTHER JOSEPH PL STE 210
VANCOUVER WA
98664-3295
US

V. Phone/Fax

Practice location:
  • Phone: 360-254-6161
  • Fax: 360-803-0847
Mailing address:
  • Phone: 360-254-6161
  • Fax: 360-803-0847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD70088001
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: