Healthcare Provider Details

I. General information

NPI: 1134616477
Provider Name (Legal Business Name): CELLUTIONS VANCOUVER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 04/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 NE 134TH ST STE 100
VANCOUVER WA
98686-3036
US

IV. Provider business mailing address

2621 NE 134TH ST STE 100
VANCOUVER WA
98686-3036
US

V. Phone/Fax

Practice location:
  • Phone: 800-280-0797
  • Fax: 360-450-4084
Mailing address:
  • Phone: 800-280-0797
  • Fax: 360-450-4084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60790564
License Number StateWA

VIII. Authorized Official

Name: JEFF TUNICK
Title or Position: MANAGING MEMBER
Credential: DC
Phone: 360-464-1492