Healthcare Provider Details

I. General information

NPI: 1194905554
Provider Name (Legal Business Name): SHELLEY DUNLOP PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NE MOTHER JOSEPH PL STE 110
VANCOUVER WA
98664-3293
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:
Mailing address:
  • Phone: 360-254-6161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61542773
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA61542773
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: